title: Effects of atorvastatin on the pharmacokinetics of everolimus among kidney transplant recipients.
abstract: BACKGROUND
  Hyperlipidemia occurs in up to 50% of kidney transplant (KT) recipients who take everolimus (EVL). As a result of this, statins are the most commonly prescribed lipid-lowering drugs among these patients. However, we are concerned whether there are any drug interactions between EVL and statins, because both of these drugs use the same pharmacokinetics pathway. Therefore, we assessed the effects of concomitant use of EVL and atorvastatin.
  
  
  METHODS
  In this randomized, open-label, crossover study, 20 KT patients were assigned (1:1) to receive EVL with or without 20 mg atorvastatin for 1 month. One-month washout period was used before crossover. Plasma EVL concentrations were measured by homogeneous particle-enhanced turbidimetric immunoassay. Twelve-hour area under the time-concentration curve (AUC0-12) of EVL was calculated with the use of whole-blood EVL concentrations from 10 different time points (0, 0.5, 1, 1.5, 2, 2.5, 4, 6, 8, and 12 hours).
  
  
  RESULTS
  The mean (SD) AUC0-12 for EVL and EVL plus atorvastatin was 155.9 (41.6) ng·h/mL and 151.3 (51.4) ng·h/mL, respectively (P > .05; paired t test). No difference of EVL Cmax or Tmax was found after atorvastatin coadministration. Even though the EVL AUC0-12 levels were not affected by atorvastatin coadministration in one-half of the subjects, for the rest of the patients, there were unpredictable changes in the EVL AUC0-12 levels. This may be due to the high intrapatient variability of EVL drug concentration (coefficient of variation ranges from 9.8% to 34.1%).
  
  
  CONCLUSIONS
  Coadministration of atorvastatin with EVL in KT recipients did not affect the pharmacokinetics of EVL.
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellent Center for Organs Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: A
authors.initials: A
authors.lastname: Wanitchanont
authors.affiliation: Immunology Unit, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Center of Excellence in Immune Diseases and Immune-Mediated Diseases, Chulalongkorn University, Bangkok, Thailand.
authors.forename: P
authors.initials: P
authors.lastname: Somparn
authors.affiliation: Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
authors.forename: S
authors.initials: S
authors.lastname: Vadcharavivad
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellent Center for Organs Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: W
authors.initials: W
authors.lastname: Chancharoenthana
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellent Center for Organs Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: N
authors.initials: N
authors.lastname: Townamchai
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellent Center for Organs Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
authors.forename: K
authors.initials: K
authors.lastname: Praditpornsilpa
authors.affiliation: Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand; Center of Excellence in Immune Diseases and Immune-Mediated Diseases, Chulalongkorn University, Bangkok, Thailand; Excellent Center for Organs Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand. Electronic address: yingyos.a@gmail.com.
authors.forename: Y
authors.initials: Y
authors.lastname: Avihingsanon
mesh_terms: D000328:Adult; D019540:Area Under Curve; D000069059:Atorvastatin; D018592:Cross-Over Studies; D000068338:Everolimus; D006538:Heptanoic Acids / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000494:pharmacology*; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics* / Q000494:pharmacology*; D016030:Kidney Transplantation; D008875:Middle Aged; D011446:Prospective Studies; D011758:Pyrroles / Q000009:adverse effects / Q000494:pharmacology*; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000494:pharmacology
chemical_list: D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007166:Immunosuppressive Agents; D011758:Pyrroles; D000068338:Everolimus; D000069059:Atorvastatin; D020123:Sirolimus