Enhanced oral cyclosporine absorption with water-soluble vitamin E early after liver transplantation.
We evaluated the effect of Liqui-E, a water-soluble vitamin E preparation, on cyclosporin A (CyA) whole blood concentration in liver transplant recipients, and its impact on the cost of CyA. Patients were 26 liver transplant recipients (19 adults, 7 children) who were unable to achieve and maintain therapeutic CyA whole blood concentrations with the standard recommended oral daily dose in the early post-transplant period. Liqui-E 6.25 IU/kg orally was administered with CyA every 12 hours (median time of starting Liqui-E day 14.5). With Liqui-E, the daily oral CyA requirements (mean +/- SD) were decreased in adults from 22.6 +/- 8.9 to 16.2 +/- 7.3 mg/kg/day (p < 0.001) and in children from 78.6 +/- 34.1 to 53.7 +/- 35.0 mg/kg/day (p < 0.02); intravenous administration of CyA was unnecessary. The CyA trough concentrations (mean +/- SD) before and after Liqui-E were 670 +/- 186 and 1012 +/- 216 ng/ml, respectively, in adults (p < 0.001) and 732 +/- 187 and 1052 +/- 166 ng/ml, respectively, in children (p < 0.01). When given with Liqui-E, the daily cost of CyA decreased by 26% in both adults and children. No clinical or biochemical evidence of Liqui-E toxicity was observed. Thus its administration in the early post-transplantation period can enhance CyA absorption in adults and children who are unable to achieve adequate whole blood concentrations with the usual recommended oral dosages. In addition, a significant cost saving can be realized by coadministration.
Pan
S H
SH
Department of Pharmacy, Cedars-Sinai Medical Center, Los Angeles, California 90057, USA.
Lopez
R R
RR
Sher
L S
LS
Hoffman
A L
AL
Podesta
L G
LG
Makowka
L
L
Rosenthal
P
P
D000042:Absorption / Q000187:drug effects; D000284:Administration, Oral; D000328:Adult; D001835:Body Weight; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage / Q000097:blood / Q000191:economics / Q000493:pharmacokinetics*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000097:blood / Q000191:economics / Q000493:pharmacokinetics*; D007275:Injections, Intravenous; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols; D011446:Prospective Studies; D014810:Vitamin E / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000097:blood / Q000494:pharmacology
D007166:Immunosuppressive Agents; D014810:Vitamin E; D011092:Polyethylene Glycols; D016572:Cyclosporine; C014225:tocophersolan