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Bone Marrow Transplantation (2004) 33, 137–152. doi:10.1038/sj.bmt.1704316 Published online 15 December 2003

Drug interactions in the hematopoietic stem cell transplant (HSCT) recipient: what every transplanter needs to know

H L Leather1

1University of Florida, Gainesville, USA

Correspondence: Dr HL Leather, Clinical Pharmacy Specialist, BMT/Leukemia, Shands at the University of Florida, 1600 SW Archer Road, Box 100316, Gainesville, FL 32610, USA. E-mail: leathhl@shands.ufl.edu

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Abstract

Pharmacokinetic drug interactions among hematopoietic stem cell transplant recipients can result in either increases in serum concentrations of medications, which may lead to enhanced toxicity; or reduced serum concentrations, which can lead to treatment failure and the emergence of post transplant complications. The use of drugs that have a narrow therapeutic index, such as cyclosporine/tacrolimus (calcineurin inhibitors), increases the significance of these interactions when they occur. This report will review the clinical data evaluating the drug interactions of relevance to HSCT clinical practice, focusing on the pharmacokinetic interactions, and provides recommendations for managing these interactions to avoid both toxicity and treatment failure.

Keywords:

drug interactions, cytochrome P450, cyclosporine, tacrolimus, pharmacokinetic, CYP3A4, azoles