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Background/Aim. A combination of tacrolimus and other drugs such as   corticosteroids has been commonly used immunosuppresive regimens. On the   other hand, there is a growing body of evidence that male and female may   differ in their response to the equal drug treatment. The aim of the study   was to estimated the use of tacrolimus concentration/dose (C/D) ratio for the   assessment of the influence of gender differences and comedication on   tacrolimus exposure in renal transplant recipients. Methods. This prospective   case series study included 54 patients, in which the unit of monitoring was   outpatient examination (1,872) of the renal transplant patients. The patients   were monitored in the period 2010-2014, starting one month after the   transplantation. Tacrolimus trough concentrations (TTC) were measured by   chemiluminescence microparticles immunoassay. Results. TTC and the   tacrolimus C/D ratio were significantly lower in the females comparing with   the males. Contrary to the males, in the females a significant increase of   the tacrolimus daily dose (TDD) per body weight and TTC, along with the   corticosteroid dose increase, was not accompanied by any significant changes   in the tacrolimus C/D ratio; in different corticosteroid doses faster   elimination of tacrolimus was found with the exception of the doses > 0.25   mg/kg. In the patients treated with proton pump inhibitors, mainly with   pantoprazole TDD per body weight and TTC were significantly higher, while the   tacrolimus C/D ratio was significantly lower compared to the patients without   this treatment. In the patients treated with calcium channel blockers, TDD   per body weight was significantly lower (particularly with amlodipine) while   the tacrolimus C/D ratio was higher compared to the patients who were not   treated by them. Conclusion. A lower tacrolimus exposure was detected in   females in comparison to males. When gender differences were considered in   the context of different corticosteroid doses, faster elimination of   tacrolimus in the females was also seen, with the exception of the doses >   0.25 mg/kg. Tacrolimus exposure in the pantoprazole-treated patients was   significantly less expressed, while in patients treated with CCB amplodipine   the tacrolimus C/D ratio was significantly higher in comparison with the   patients not treated with them. [Projekat Ministarstva nauke Republike   Srbije, br. 175014 and 175093

Tacrolimus concentration/dose ratio as a therapeutic drug monitoring strategy: The influence of gender and comedication