Document Detail


Interpreting tacrolimus concentrations during pregnancy and postpartum.
MedLine Citation:
PMID:  23274970     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Pregnancy after solid organ transplantation, although considered high risk for maternal, fetal, and neonatal complications, has been quite successful. Tacrolimus pharmacokinetic changes during pregnancy make interpretation of whole blood trough concentrations particularly challenging. There are multiple factors that can increase the fraction of unbound tacrolimus, including but not limited to low albumin concentration and low red blood cell count. The clinical titration of dosage to maintain whole blood tacrolimus trough concentrations in the usual therapeutic range can lead to elevated unbound concentrations and possibly toxicity in pregnant women with anemia and hypoalbuminemia. Measurement of plasma or unbound tacrolimus concentrations for pregnant women might better reflect the active form of the drug, although these are technically challenging and often unavailable in usual clinical practice. Tacrolimus crosses the placenta with in utero exposure being approximately 71% of maternal blood concentrations. The lower fetal blood concentrations are likely due to active efflux transport of tacrolimus from the fetus toward the mother by placental P-glycoprotein. To date, tacrolimus has not been linked to congenital malformations but can cause reversible nephrotoxicity and hyperkalemia in the newborn. In contrast, very small amounts of tacrolimus are excreted in the breast milk and are unlikely to elicit adverse effects in the nursing infant.
Authors:
Mary F Hebert; Songmao Zheng; Karen Hays; Danny D Shen; Connie L Davis; Jason G Umans; Menachem Miodovnik; Kenneth E Thummel; Thomas R Easterling
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Transplantation     Volume:  95     ISSN:  1534-6080     ISO Abbreviation:  Transplantation     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-03     Completed Date:  2013-07-08     Revised Date:  2014-04-17    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  908-15     Citation Subset:  IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Breast Feeding
Drug Monitoring*
Female
Fetal Blood / metabolism
Fetus / drug effects
Humans
Immunosuppressive Agents / adverse effects,  blood*,  pharmacokinetics
Maternal Exposure
Maternal-Fetal Exchange
Milk, Human / metabolism
Organ Transplantation*
Placental Circulation
Postpartum Period / blood*
Pregnancy
Pregnancy Complications / blood,  immunology,  prevention & control*
Protein Binding
Risk Assessment
Risk Factors
Tacrolimus / adverse effects,  blood*,  pharmacokinetics
Grant Support
ID/Acronym/Agency:
R01 GM068871/GM/NIGMS NIH HHS; R01 GM068871/GM/NIGMS NIH HHS; U10 HD047890/HD/NICHD NIH HHS; U10 HD047891/HD/NICHD NIH HHS; U10 HD047892/HD/NICHD NIH HHS; U10HD047890/HD/NICHD NIH HHS; U10HD047891/HD/NICHD NIH HHS; U10HD047892/HD/NICHD NIH HHS; UL1 RR025014/RR/NCRR NIH HHS; UL1 RR031975/RR/NCRR NIH HHS; UL1 TR000101/TR/NCATS NIH HHS; UL1 TR000423/TR/NCATS NIH HHS; UL1RR025014/RR/NCRR NIH HHS; UL1RR031975/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents; WM0HAQ4WNM/Tacrolimus
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  The Clinical and Molecular Significance of C4d Staining Patterns in Renal Allografts.
Next Document:  Blood Group Antigen-Targeting Peptide Suppresses Anti-Blood Group Antibody Binding to Antigen in Ren...