Mycophenolate mofetil has an important role as immunosuppressive agent in solid organ transplant recipients. Exposure to the active mycophenolic acid (MPA) can be monitored using therapeutic drug monitoring. We present three cases in which MPA exposure severely decreased after oral antibiotic coadministration. By diminishing gut bacteria β‐glucuronidase activity, oral antibiotics can prevent deglucuronidation of the inactive MPA‐7‐O‐glucuronide metabolite to MPA and thereby possibly prevent its enterohepatic recirculation. This pharmacokinetic interaction could result in rejection, which makes it clinically relevant in solid organ transplant recipients, especially when therapeutic drug monitoring frequency is low. Routine screening for this interaction, preferably supported by clinical decision support systems, and pragmatic close monitoring of the MPA exposure in cases is advised.
Mycophenolate mofetil has an important role as immunosuppressive agent
in solid organ transplant recipients. Exposure to the active
mycophenolic acid (MPA) can be monitored using therapeutic drug
monitoring. We present three cases in which MPA exposure severely
decreased after oral antibiotic co-administration. By diminishing gut
bacteria β-glucuronidase activity, oral antibiotics seem to prevent
deglucuronidation of the inactive MPA-7-O-glucuronide metabolite to MPA
and thereby prevent its enterohepatic recirculation. This
pharmacokinetic interaction could result in rejection, which makes it
clinically relevant in solid organ transplant recipients, especially
when therapeutic drug monitoring frequency is low. Routine screening for
this interaction, preferably supported by clinical decision support
systems, is advised.
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