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Specialty Pharmacy

Transplant

BrandGeneric
CellCept Myfortic Mycofenolate Mycofenolate Mofetil (Not equivalent) Maintenance MOA: decreases T-cell proliferation via purine synth inhibition Take on an empty stomach BBW/REMS: pregnancy ADE: SEVERE diarrhea Desired Trough: 1-3.5 dose ~ 1g bid
Gengraf/Neoral SandIMMUNE Cyclosporine(mod) Cyclosporine(unmod) Maintenance MOA: inhibits production and release of IL-2, preventing T-cell activation(calcineurin inhibitor) BBW: HTN, Nephrotox Desired Trough: 100-400 ng/ml Dose ~ 8mg/kg div BID
Nulojix Belatacept Kidney- yes, EBV positive only Lung-maybe Liver- NEVER Maintenance MOA:Blocks T-cell comstim and cytokine release via CD80/86 blocking dose: 10mg/kg to the nearest 12.5mg DRUG SHORTAGE, no new patients
Rapamune Sirolimus Maintenance MOA: mTor Kinase inhibitor blocks T-cell activation/proliferation dose ~1-5 mg QD Trough goal: 4-12 ng/ml
Zortress/Afinitor Everolimus Maintenance MOA: mTor Kinase inhibitor blocks T-cell activation/proliferation dose~ 1mg BID Trough Goal: 3-8ng/ml
Simulect Basiliximab Induction MOA: Blocks IL-2 receptor on T-cells
ATGAM Thymoglobulin Antithymocyte Globulin- Horsey Antithymocyte Globulin- Rabbit Induction MOA: binds and flags T-cells for destruction Infusion reaction, HAMA
Imuran,Azasan Azathioprine Maintenance MOA: Blocks DNA and purine synthesis (guanine) Unique ADES: Hepatotoxic,Anemias Genomics- TPMT deficient dosing DDI: Allopurinol (increased AZA =tox!) dose~1-3 mg/kg QD
General Transplant Info (maintenance drugs) these drugs also used in autoimmune disorders(psoriasis,RA,lupus) Malignancy- wear suncreen, avoid tanning Infection Risk- No live vaccines, get flu, avoid, sick people DDI's/FDI's: TONS of DDI's, important thing is consistency and communication with physician Monitoring/ADES- Blood sugar (DM), BP, Lipids, SCr, CBC, and TROUGH levels.
Astagraff XL/Prograf Tacrolimus Maintenance MOA: Calcineurin inhibitor, prevents t-cell activation Routes: PO,SL,IV (4:2:1) 1st line! BBW: Mortality in liver transplant(XL)
Created by: Briovastudent
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