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 CASE REPORT
Year : 2013  |  Volume : 23  |  Issue : 1  |  Page : 71-73

Combined approach with therapeutic drug monitoring and pharmacogenomics in renal transplant recipients


1 Department of Pharmacology, Clinical Pharmacology Unit, Vellore, India
2 Department of Nephrology, Christian Medical College, Vellore, India

Correspondence Address:
B S Mathew
Clinical Pharmacology Unit, Christian Medical College Hospital, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.107216

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In patients undergoing renal transplantation, dose individualization for tacrolimus is routinely achieved with therapeutic drug monitoring (TDM). The patient started on 5.5 mg/day of tacrolimus had a significantly elevated tacrolimus trough concentration. The tacrolimus dose was regularly reduced following TDM at many time periods in the post transplant period but the tacrolimus concentration was consistently elevated. Genomic analysis done after four years revealed mutations in the genes encoding for CYP3A5 and MDR1 (2677G > T). Pharmacogenomics alongside TDM, will soon emerge as the backbone of dose individualization. But for genomics to be beneficial, it should be advocated in the pre-transplant or early post transplant period.






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Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07