Pharmacokinetics of mycophenolate mofetil and intravenous ganciclovir alone and in combination in renal transplant recipients.
OBJECTIVE
To evaluate the pharmacokinetics of mycophenolic acid and its glucuronide metabolite alone and in the presence of ganciclovir, and to determine the pharmacokinetics of ganciclovir alone and in combination with mycophenolate mofetil.


METHODS
Randomized, open-label, three-way crossover study.


METHODS
Twelve kidney transplant recipients.


METHODS
Mycophenolate mofetil 1500 mg orally and ganciclovir 5 mg/kg intravenously were each given alone and in combination with at least a 1-week washout period between treatment arms.


RESULTS
Blood samples were obtained to measure mycophenolic acid and ganciclovir by high-performance liquid chromatography. Mean (+/-SD) oral plasma clearance for mycophenolic acid alone and with ganciclovir was 3.11 +/- 0.72 and 3.19 +/- 0.72 ml/min/kg (p = 0.64). The overall disposition of the major metabolite, MPA-glucuronide, was unchanged, with approximately 70% of the administered dose eliminated as the glucuronide conjugate for both arms of the study. Mean genciclovir serum clearance was 1.80 +/- 0.58 ml/min/kg for ganciclovir and 1.70 +/- 0.55 ml/min/kg for ganciclovir plus mycophenolate mofetil (p = 0.11; 10 patients). Renal clearance of ganciclovir was decreased when the drugs were administered in combination, 1.43 +/- 0.54 (ganciclovir) and 1.26 +/- 0.44 (both drugs) ml/min/kg (p = 0.02; 10 patients).


CONCLUSIONS
The single-dose pharmacokinetics of mycophenolic acid and its glucuronide metabolite were unchanged by the addition of ganciclovir. Total serum clearance of ganciclovir was unchanged by the addition of mycophenolate mofetil, however, renal clearance was slightly decreased.
Wolfe
E J
EJ
College of Pharmacy, University of Iowa, Iowa City, USA.
Mathur
V
V
Tomlanovich
S
S
Jung
D
D
Wong
R
R
Griffy
K
K
Aweeka
F T
FT
D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D018592:Cross-Over Studies; D004347:Drug Interactions; D015774:Ganciclovir / Q000008:administration & dosage / Q000493:pharmacokinetics*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D011355:Prodrugs / Q000008:administration & dosage / Q000493:pharmacokinetics*
D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D011355:Prodrugs; D009173:Mycophenolic Acid; D015774:Ganciclovir