Adsorption and pharmacokinetics of cyclosporin A in relation to mode of infusion in bone marrow transplant patients

Abstract

Summary:Two main factors that affect the pharmacokinetics of cyclosporin A (CsA) during 24-h durable intravenous (DIV) administration have been reported, namely physiological changes after bone marrow transplantation, and blood sampling through indwelling lines. In addition, it has been found that infusion sets made of polyvinyl chloride (PVC) markedly adsorb CsA. We conducted in vitro adsorption studies of CsA on infusion sets, and the administration routes that are used in the treatment of patients with bone marrow transplantation. We also examined the effects of administration route on CsA pharmacokinetics in clinical practice. The in vitro adsorption study using 30-mm segments of lumen from commercially available infusion sets showed that the degree of CsA adsorption per area of lumen made of PVC was significantly higher than that in those made of polyethylene (PE) or polybutadiene (PB), which showed no adsorption of CsA. Due to its adsorption, use of infusion sets made of PVC resulted in about a 40-50% loss of CsA dose, which affected the pharmacokinetic parameters during 24-h DIV, while those made of PE and PB did not. The use of non-PVC infusion sets should allow for accurate monitoring of CsA results, and provide cost benefit in the treatment of bone marrow transplantation. Bone Marrow Transplantation (2000) 25, 633-638.

Clinical Validation of Dried Blood Spot Sampling in Therapeutic Drug Monitoring of Ciclosporin A in Allogeneic Stem Cell Transplant Recipients

“…1,2 To optimize the efficacy of CsA while minimizing the toxicity, therapeutic drug monitoring (TDM) is therefore essential. 1,2 To optimize the efficacy of CsA while minimizing the toxicity, therapeutic drug monitoring (TDM) is therefore essential.…”

Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood

“…Immunosuppressive agents, such as cyclosporine, are defined by a narrow therapeutic window and low serum concentrations of these drugs might lead to acute graft rejection. Although a previous study suggested in vitro adsorption studies of cyclosporine on PVC infusion sets significantly higher than that in those made of polyethylene or polybutadiene [ 21 ], this study is the first to evaluate cyclosporine pharmacokinetics in ECMO patients. Our results suggested that cyclosporine concentration decreases slowly in the ECMO circuit with 66% of the initial concentration remaining in the circuit after 48 hours.…”

A comparison of the pharmacokinetic and pharmacodynamic properties of nitroglycerin according to the composition of the administration set

“…The risk of drug sorption into the administration set has been well documented. [ 1 – 3 ] Drug sorption can influence the prognosis of patients by preventing them from receiving the physician-intended drug dosage. Nitroglycerin is a nitrate used for vasodilation in patients with hypertension and ischemic heart disease.…”