The effect of beta blocker use on cyclosporine level in cardiac transplant recipients

Bader, Feras; Hagan, Mary E.; Crompton, Jason A.; Gilbert, Edward M.

doi:10.1016/j.cardfail.2004.06.271

Cited by 3 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To our knowledge, these are the first data on the effect of carvedilol on the bioavailability of tacrolimus in liver transplant recipients. Nevertheless, this observation confirms the results of Kaijser et al36 in kidney transplant recipients and those of Bader et al37 in cardiac transplant recipients. In particular, Bader et al recently supposed that carvedilol influences CNI levels through its effect on a membrane protein that regulates CNI absorption.…”

Section: Discussionsupporting

confidence: 91%

Nifedipine versus carvedilol in the treatment ofde novoarterial hypertension after liver transplantation: Results of a controlled clinical trial

et al. 2008

View full text Add to dashboard Cite

The aim of this study was to compare nifedipine and carvedilol in the treatment of de novo arterial hypertension after orthotopic liver transplantation (OLT). The study included 50 patients who developed arterial hypertension after OLT. Twenty-five patients received nifedipine (group A), and 25 received carvedilol (group B). Patients were defined as intolerant to nifedipine or carvedilol if severe adverse effects developed. These patients stopped the first drug and were switched to the other one. Patients were defined as full responders to monotherapy if there was normalization of blood pressure, and they were defined as partial responders by the need to add a second antihypertensive drug, ramipril. The 2 groups of patients were similar for baseline conditions. At the end of the study, patients intolerant to monotherapy were 48% of group A and 12.5% of group B (P Ͻ 0.01). Full responders were 20% of group A and 33.33% of group B (P Ͻ 0.01). Partial responders were 22% of group A and 54.1% of group B (P Ͻ 0.01). The addition of ramipril normalized blood pressure in 19% of partial responders to monotherapy (75% in partial responders to nifedipine and 30% in partial responders to carvedilol, P Ͻ 0.01). In responders to either monotherapy or combined therapy, there was a significant improvement of renal function. In responders to carvedilol, but not in responders to nifedipine, the daily dose of tacrolimus at 1 year should be reduced to 50% compared to the baseline dose to maintain the blood trough level in the therapeutic range. Liver Transpl 14: [1020][1021][1022][1023][1024][1025][1026][1027][1028] 2008. © 2008 AASLD. Received September 30, 2007; accepted January 9, 2008.Liver transplantation is the standard care for end-stage liver disease and for fulminant hepatic failure. During recent years, advances in both medical management and surgical techniques have led to an increase in graft and patient survival following orthotopic liver transplantation (OLT). Nowadays, patient survival after OLT is about 85% at 5 years 1 and 70% at 10 years. 2Early mortality (within 1 year after OLT) has been reduced. The major causes of early mortality are infections, surgical complications, allograft failure due to primary allograft dysfunction, and allograft rejection.Late complications are increased because of the enhancement of survival after OLT. Major late complications are cardiovascular events, metabolic complications, renal dysfunction, disease recurrence, and malignancy. Arterial hypertension is one of the major late complications after liver transplantation and is an important risk factor for cardiovascular events. De novo arterial hypertension is defined as the development of arterial blood pressure Ͼ 140/90 mm Hg in patients that were normotensive before OLT.3 De novo arterial hypertension has a prevalence exceeding 50% after liver trans-

show abstract

Section: Discussionsupporting

confidence: 91%

Nifedipine versus carvedilol in the treatment ofde novoarterial hypertension after liver transplantation: Results of a controlled clinical trial

et al. 2008

View full text Add to dashboard Cite

show abstract

“…For example, the inadvertent use of clarithromycin, an inhibitor of the cytochrome P‐450 3A4 pathway, for a simple urinary tract infection can double the serum TAC level and result in significant nephrotoxicity. P‐glycoprotein is a cell membrane‐associated protein that transports a variety of drug substances and influences drug absorption (in the intestine) and elimination (in the liver and kidney) (7). Carvedilol, a nonselective beta‐blocker with alpha‐blocking properties is metabolized by the cytochrome P‐450 2D6, but not the P‐450 3A4 pathway.…”

Section: Immunosuppressive Medicationsmentioning

confidence: 99%

“…Carvedilol, a nonselective beta‐blocker with alpha‐blocking properties is metabolized by the cytochrome P‐450 2D6, but not the P‐450 3A4 pathway. Carvedilol has been shown to increase serum levels of CNIs by inhibiting the P‐glycoprotein pathway (7,8). Other frequent potential interactions include allopurinol (which can increase levels of antimetabolites to toxic levels, especially AZA), nonsteroidal anti‐inflammatory medications (NSAIDs) (which can potentiate CNI‐induced nephrotoxicity) and spironolactone, which can increase CNI‐induced hyperkalemia.…”

Section: Immunosuppressive Medicationsmentioning

confidence: 99%

Long-term Management of the Liver Transplant Patient: Recommendations for the Primary Care Doctor

McGuire

Rosenthal

Brown

et al. 2009

American Journal of Transplantation

View full text Add to dashboard Cite

No official document has been published for primary care physicians regarding the management of liver transplant patients. With no official source of reference, primary care physicians often question their care of these patients. The following guidelines have been approved by the American Society of Transplantation and represent the position of the association. The data presented are based on formal review and analysis of published literature in the field and the clinical experience of the authors. These guidelines address drug interactions and side effects of immunosuppressive agents, allograft dysfunction, renal dysfunction, metabolic disorders, preventive medicine, malignancies, disability and productivity in the workforce, issues specific to pregnancy and sexual function, and pediatric patient concerns. These guidelines are intended to provide a bridge between transplant centers and primary care physicians in the long-term management of the liver transplant patient.

show abstract

“…A potential issue with β‐blockade following transplantation is that cyclosporin levels may elevate (specific to carvedilol use) [19]. The proposed interaction is through the modulation of P‐glycoprotein, a membrane bound efflux pump that regulates cyclosporin absorption.…”

Section: Heart Rate Manipulationmentioning

confidence: 99%

“…The proposed interaction is through the modulation of P‐glycoprotein, a membrane bound efflux pump that regulates cyclosporin absorption. Given that raised cyclosporin has been associated with nephrotoxicity [20], in vivo cardiotoxicity [21] and an increased risk of malignancy [22], it has therefore been advised that a 10% dose reduction of cyclosporin should be considered upon the initiation of carvedilol [19].…”

Section: Heart Rate Manipulationmentioning

confidence: 99%

The Usefulness of Chronic Heart Failure Treatments in Chronic Cardiac Graft Failure

Najam

Yonan

Williams

et al. 2010

Cardiovascular Therapeutics

View full text Add to dashboard Cite

Following cardiac transplantation, registry data has demonstrated a gradual improvement in survival over the last several decades, which is testament to continual improvement in aftercare strategy. However, a significant number of patients will eventually develop a new syndrome of chronic heart failure, owing to the multitude of physiological processes that occur after transplantation. This condition, referred to as chronic graft failure (CGF) should be regarded as a unique illness rather than one that is simply analogous with chronic heart failure. In particular, the unique pathophysiological (and pharmacological) environment in the setting of CGF presents a challenging situation to the transplant physician. There is uncertainty over which treatments to offer given a paucity of clinical trial data to support the use of standard heart failure treatments in CGF. In this review, we discuss which chronic heart failure treatments could be considered in the setting of CGF based on their mechanisms of action, benefits within the native heart failure setting, and the relevant issues within the posttransplant environment.

show abstract

The effect of beta blocker use on cyclosporine level in cardiac transplant recipients

Cited by 3 publications

References 0 publications

Nifedipine versus carvedilol in the treatment ofde novoarterial hypertension after liver transplantation: Results of a controlled clinical trial

Nifedipine versus carvedilol in the treatment ofde novoarterial hypertension after liver transplantation: Results of a controlled clinical trial

Long-term Management of the Liver Transplant Patient: Recommendations for the Primary Care Doctor

The Usefulness of Chronic Heart Failure Treatments in Chronic Cardiac Graft Failure

Contact Info

Product

Resources

About