Thoracic transplantationSublingual Tacrolimus as an Alternative to Intravenous Route in Patients With Thoracic Transplant: A Retrospective Study
Section snippets
Patients
This retrospective longitudinal study was performed from 2005 to 2008 in eligible patients who received SL TRL administration during their hospitalization because the oral route was unavailable. Patients were followed with therapeutic drug monitoring to adjust dosing to blood concentrations of TRL. The feasibility of the SL route of TRL administration was documented in a few patients undergoing rich pharmacokinetic sampling.27
Modality of Sublingual Tacrolimus Administration
Sublingual TRL administration was performed using Prograf oral
Blood Concentration Assessments
Blood levels were analyzed using the tacrolimus II assay (IMx, Abbott, Chicago, Illinois, USA) based on microparticle enzyme immunoassay technology. The test quantitatively estimates TRL concentration of 3–30 ng/mL. The analytic limit of detection of the test amounts to 1.2 ng/mL, whereas its functional limit of quantification at 20% coefficient of variation amounts to 1.4 ng/mL. Whole blood samples were collected with EDTA venous blood collection. Those samples which were an integral part of
Patients
In our cohort, 16 patients received SL tacrolimus, representing 17 clinical TDMs. Table 1 summarizes their major demographic data and the clinical rationale for use of the SL as an alternative to the IV route. The mean age of the patients was 35 ± 17 years, with predominantly a male distribution (n = 13). The main recipients were lung transplant patients (n = 13), with 10 (71.4%) bilateral lung transplants because of end-stage cystic fibrosis. Gastrointestinal disorders represented the most
Discussion
This study showed the potential benefit and safety of the TRL SL route as an alternative to the IV route for short-term therapy. TRL is a strong immunosuppressant with narrow therapeutic range. Monitored therapy plays an important role to control for efficacy versus adverse effects, such as nephrotoxicity and neurotoxicity. TRL overexposure is also accompanied by increased immunosuppressive effects, which can lead to an increased risk of opportunistic infections and malignancies.28, 29, 31, 33,
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Cited by (23)
The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipients
2023, Journal of Heart and Lung TransplantationConventional and Novel Approaches to Immunosuppression in Lung Transplantation
2023, Clinics in Chest MedicineSublingual Tacrolimus in Liver Transplantation: A Valid Option?
2016, Transplantation ProceedingsCitation Excerpt :In select transplant patients, SL administration of Tac has emerged as an alternate route of drug delivery. Although the use of SL Tac has not been reported in LT patients, its utility as the primary maintenance immunosuppression in heart and lung transplant recipients has been investigated [9–14]. In a prospective observational study, 6 lung transplant recipients were maintained on SL Tac, and therapeutic trough concentrations were achieved in 4 (67%) of the patients [9].
Use of sublingual tacrolimus in lung transplant recipients
2012, Journal of Heart and Lung TransplantationDrugs that act on the immune system: Immunosuppressive and immunostimulatory drugs
2012, Side Effects of Drugs AnnualCitation Excerpt :Because it is easy to administer and has satisfactory pharmacokinetics, sublingual tacrolimus is an attractive option when the oral route is prohibited. In a retrospective analysis of 17 lung and heart transplant patients, tacrolimus was administered sublingually and 90% of blood concentrations were within the target range [153c]. Acute rejection episodes, renal toxicity, and drug interactions were not observed.
Population pharmacokinetics of sublingually administered tacrolimus in infants and young children with liver transplantation
2023, British Journal of Clinical Pharmacology