Effect of Ganciclovir on Pharmacokinetics of Mycophenolic Mofetil, in Kidney Transplant Patients

ObjectiveMycophenolate mofetil (MMF) is commonly administered concomitantly with ganciclovir for managingtransplant recipients who infected with CMV. This study was conducted to evaluate the probable effects ofganciclovir on Mycophenolic acid (MPA) pharmacokinetic.Materials and MethodsTen kidney transplant recipients who full field inclusion and exclusion criterias enrolled in this study. Thefirst full profile blood sampling was taken during the combination therapy of gancyclovir and MMF. Thesecond sampling was taken one week after discontinuation of gancyclovir. Serum concentrations of MPAand its glucuronide metabolite (MPAG) were determined by high-performance liquid chromatography(HPLC) method. The pharmacokinetic parameters of MPA were measured, in two conditions, for eachpatient.ResultsThere was no significant difference between MPA clearance alone and in combination with ganciclovir(۲۸.۲
۲۱.۹ L/h vs ۳۱.۹
۲۱.۳ L/h, p=۰.۲۰۷) and also no significant difference was seen between the MPAArea Under the Curve (AUC) in two conditions (۴۳.۴۸
۱۶.۲۷ μg/mlh vs ۳۹.۸۰
۲۰.۱۸ μg/mlh, p=۰.۲۲۱).MPAG AUC was increased significantly when the drugs were administrated in combination (۹۵۷.۸
۶۷۵.۲μg/mlh vs ۱۳۴۸۶
۱۰۹۵.۱μg/mlh, p=۰.۰۳۶). Also ganciclovir induced entrohepatic recirculation of MPA intwo patients.ConclusionThe pharmacokinetic parameter of MPA was not affected by ganciclovir. But ganciclovir increased MPAGAUC and induced enterohepatic recirculation of MPA

Keywords:

Clearance , Kidney Transplantation , Ganciclovir , Mycophenolic acid