title: Ferrous sulfate does not affect mycophenolic acid pharmacokinetics in kidney transplant patients.
abstract: BACKGROUND
  Oral administration of ferrous-sulfate was reported to decrease intestinal absorption of mycophenolate mofetil (MMF) in healthy Japanese individuals by 90%.
  
  
  METHODS
  We examined the effect of a single oral dose of ferrous sulfate on steady-state mycophenolic acid pharmacokinetics in 10 iron-deficient (hypochromic red blood cells >2.5%), Caucasian, long-term kidney graft recipients using a randomized, open-label, crossover design. On days A and B, MMF (1,000 mg) was given orally at 8:00 am. On day C, MMF and ferrous sulfate (105 mg) were coadministered at 8:00 am. On day D, MMF was given at 8:00 am and ferrous sulfate was given orally 4 hours later.
  
  
  RESULTS
  The interindividual variability of the 12-hour area under the plasma mycophenolic acid concentration versus time curves (AUC(0-12)) under control conditions was small (89.5 +/- 27.8 and 87.6 +/- 39.1 mg x h/L, respectively). Concomitant or subsequent administration of MMF and ferrous sulfate did not affect the bioavailabilty of MMF (AUC(0-12), 91.9 +/- 30.4 mg x h/L and 96.0 +/- 31.7 mg x h/L).
  
  
  CONCLUSIONS
  Oral therapy of iron deficiency using ferrous sulfate in long-term kidney graft recipients does not impede intestinal absorption of MMF; hence, exposure to this immunosuppressive agent is not reduced.
authors.affiliation: Department of Medicine III, Division of Nephrology and Dialysis, and Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria. matthias.lorenz@univie.ac.at
authors.forename: Matthias
authors.initials: M
authors.lastname: Lorenz
authors.forename: Michael
authors.initials: M
authors.lastname: Wolzt
authors.forename: Günter
authors.initials: G
authors.lastname: Weigel
authors.forename: Heidi
authors.initials: H
authors.lastname: Puttinger
authors.forename: Walter H
authors.initials: WH
authors.lastname: Hörl
authors.forename: Manuela
authors.initials: M
authors.lastname: Födinger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Speiser
authors.forename: Gere
authors.initials: G
authors.lastname: Sunder-Plassmann
mesh_terms: D000284:Administration, Oral; D000747:Anemia, Hypochromic / Q000097:blood / Q000188:drug therapy; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000188:drug therapy; D019540:Area Under Curve; D001682:Biological Availability; D018592:Cross-Over Studies; D004347:Drug Interactions; D004912:Erythrocytes / Q000737:chemistry; D005260:Female; D005296:Ferrous Compounds / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007408:Intestinal Absorption / Q000187:drug effects; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000097:blood / Q000378:metabolism / Q000493:pharmacokinetics* / Q000627:therapeutic use; D013995:Time; D013997:Time Factors
chemical_list: D005296:Ferrous Compounds; C020748:ferrous sulfate; D009173:Mycophenolic Acid