The Pharmacokinetics of Prednisolone and Prednisone in Adult Liver Transplant Recipients Early After Transplantation

Abstract

This study demonstrated large intraindividual and interindividual variabilities in glucocorticoid pharmacokinetics. The results suggest that current prednisolone dosing early after liver transplantation might be too high, in particular when coadministered with methylprednisolone. These findings indicate a potential for improvement by personalized dosing of glucocorticoids in organ transplantation.

Exposure–effect relationship of mycophenolic acid and prednisolone in adult patients with lupus nephritis

“…The analyses evaluated drug exposures in relation to treatment response since starting MPA and drugrelated adverse events. [7][8][9][10][11][12][13][14][15][16][17][18][19] was observed in patients with lowest tertile exposure to both total MPA and prednisolone as compared with patients with middle and higher tertile exposure (17% vs. 74%, P = 0.023). …”

“…However, substantial between-subject variability in total prednisolone pharmacokinetics has been observed in childhood-onset systemic lupus erythematosus (SLE) [9] and transplant recipients [10][11][12]. Based on limited data, there is a possible relationship between total prednisolone exposure and SLE disease activity as well as the occurrence of some drug-related side effects [9].…”

A Rationale for Age-Adapted Immunosuppression in Organ Transplantation

“…81 Adult liver transplant recipients have shown a broad intra- and interindividual variability in medication pharmacokinetics. 82 At the same time, hepatic impairment has shown conflicting data on prednisolone and prednisone metabolism in non-transplant patients. 83 Interestingly, CYP3A4 inhibitors decrease the clearance and increase the bioavailability of prednisolone and methylprednisolone.…”

Postoperative Transplant Immunosuppression in the Critical Care Unit

“…12 Methylprednisolone at a dose of 500 mg to 1500 mg is given perioperatively, followed by daily tapering doses. Steroids have the ability to work in various parts of the immune system, but they largely block activation of T cells.…”

“…12 Most commonly, oral prednisone, oral methylprednisolone, or IV methylprednisolone are used as part of the maintenance immunosuppression regimen. 12 Most commonly, oral prednisone, oral methylprednisolone, or IV methylprednisolone are used as part of the maintenance immunosuppression regimen.…”