Pharmacotherapy of Prograf (Tacrolimus) in Liver Transplant Recipients; Consideration of Its' Levels with Efficacy and Toxicity

Abstract

Context: Cytochrome P450 (CYP3A) enzymes are basic for the metabolism of several medications such as tacrolimus, as immunosuppression with tacrolimus in men prevents allograft rejection and reverses steroid-resistant rejection in transplanted recipients. Evidence Acquisition: The aim of this study was to determine a proper guideline for tacrolimus (prograf) prescription after organ transplantation. Methods: The key words relevant to topics of tarcolimus pharmacotherapy were searched. Consequently, articles related to efficacy and toxicity of tacrolimus in organ transplant recipients were selected and studied entirely. Results: The results showed that tacrolimus dosage might vary with the indication for transplantation, time after grafting, and the genotype of CYP3A. Hepatic dysfunction may impair drug disposition as a result of decreased metabolic activity through parenchymal damage and compromised biliary excretion of parent drug and metabolites during cholestasis. Conclusions: To avoid side effects, in prescribing tacrolimus such as acute rejection and toxicity, further investigation for more direct markers related to the differentiation between immunosuppressive activity due to parent drug and side effects due to metabolites within Iranian population of organ transplantation seems to be advantageous.