163 - The Two-Drug Tango: A Concise Guide to Tacrolimus and Mycophenolate in Organ Transplantation

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Sean P. Kane, PharmD, BCPS

Health & Fitness, Medications, Rosalindfranklin, Rfums, Pharmacy, Pharmd, Pharmacist, Medicine, Drugs

5 • 644 Ratings

🗓️ 4 April 2023

⏱️ 54 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode, we review clinical pearls and common pitfalls of immunosuppression regimens for organ transplantation with a particular focus on tacrolimus and mycophenolate.

Key Concepts

Most recipients of an organ transplantation will be on a two or three drug regimen. The most common regimen is tacrolimus and mycophenolate with/without a corticosteroid.
Tacrolimus is hepatically eliminated and susceptible to CYP3A4 and PGP drug interactions. Particularly at higher drug concentrations, it is associated with nephrotoxicity and neurotoxicity (among several other adverse effects).
Mycophenolate is unstable in the acidic environment of the stomach. The two formulations on the market are CellCept (which uses a prodrug, mycophenolate mofetil, that is converted in the liver to an active compound) and Myfortic (an enteric-coated formulation of mycophenolic acid, which releases after exiting the stomach).
The intensity of an immunosuppression regimen is determined by numerous factors, including the type of organ, how long ago the organ was transplanted, if acute rejection has occurred in the past, patient-specific risk factors, and more.

Additional Resources

Register to be a donor at Donate Life America (https://donatelife.net) or at the HRSA OrganDonor.gov site (https://www.organdonor.gov)
Learn more about stem cell donation and transplant at https://bethematch.org

Transcript

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0:00.0	Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions.
0:11.0	This podcast is provided by pharmacists and faculty members at Rosal Franklin University College of Pharmacy.
0:17.0	This podcast contains general information for educational purposes only. This is not professional
0:22.4	advice and should not be used in lieu of obtaining advice from a qualified health care provider.
0:27.1	And now on to the show.
0:31.1	Welcome to Helix Talk episode 163. I'm your co-host, Dr. Kane. I'm Dr. Patel.
0:38.0	And we're excited to have a guest podcast host with us today, Dr. Katie Cunningham.
0:43.1	Dr. Cunningham, maybe you could introduce yourself and just tell the audience a little bit about
0:47.3	who you are and why you're here today.
0:49.6	Yes, thank you so much for having me today.
0:51.9	I'm really excited to be here.
0:53.7	I am one of the clinical faculty members at RFU.
0:57.0	I practice at Northwestern Memorial Hospital in Solid Organ Transplant.
1:02.0	So I work on mostly the abdominal transplant team, but also have been a part of the lung transplant team as well.
1:09.0	We'll get more into your credentials in just a second, but of course we need to tell the audience
1:13.6	the title of today's episode, which is the two drug tango, a concise guide to tachrolomus and
1:19.3	mycophenylate and organ transplantation. And before we get into the episode, I did want to mention
1:24.1	that Helix Talk episode 162, which went live a couple weeks ago,
1:29.3	that has a continuing education one hour of CE credit.
1:32.7	So if you're a pharmacist and you would like some CE credit, there's still time to do that.
1:36.8	It will be open for a year since it was published, but you might as well take advantage of that now.
1:41.8	So again, episode 162 for a $5 fee, you can get an hour of CE for that episode.
	...

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