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Clinical and Medicoeconomic Impact of the Cyclosporine‐Diltiazem Interaction in Renal Transplant Recipients
Author(s) -
Smith Curtis L.,
Hampton Edward M.,
Pederson James A.,
Pennington Larry R.,
Bourne David WA.
Publication year - 1994
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/j.1875-9114.1994.tb02839.x
Subject(s) - diltiazem , pharmacokinetics , medicine , volume of distribution , drug interaction , pharmacology , renal transplant , urology , renal function , ciclosporin , immunosuppression , transplantation , calcium
The effect of the diltiazem‐cyclosporine interaction on cyclosporine pharmacokinetics, pharmacodynamics, and pharmacoeconomics was studied in 10 recipients of renal allografts. Each subject was studied while receiving diltiazem 60 mg twice/day and while not taking the drug. After achieving steady‐state conditions, cyclosporine and metabolite concentrations were determined in whole blood from samples drawn after the morning cyclosporine dose. After pharmacokinetic analysis, all patients were followed for 6 months during treatment with cyclosporine plus diltiazem or cyclosporine alone. Cyclosporine blood clearance decreased significantly after treatment with diltiazem (18.0–11.0 ml/minkg; p=0.008). The apparent volume of cyclosporine distribution also decreased significantly (4.26–2.62 L/kg; p<0.05). After 6 months, diltiazem had no effect on renal function indexes, and no apparent effect on immunosuppression. Alterations in cyclosporine clearance and apparent volume of distribution secondary to diltiazem result in dosage reduction and potential cost savings in transplant pharmacotherapy. The mean decrease in cyclosporine dosage requirements would produce a cost saving of $1520 or 28% per patient per year.