Clinical Pharmacology and Therapeutic Drug Monitoring of Immunosuppressive Agents

Abstract

Immunosuppressive drugs are used to reduce the immune response in organ transplantation and autoimmune disease. The pharmacokinetics of the immunosuppressive drugs is complex and unpredictable. Therapeutic drug monitoring plays a key role in helping clinicians maintain blood and plasma levels of immunosuppressive drugs within their respective therapeutic ranges. This chapter briefly reviews some immunosuppressive drugs: cyclosporine, tacrolimus, mycophenolic acid, sirolimus, everolimus, azathioprine, daclizumab and basiliximab, alemtuzumab and glucocorticoids. A general discussion of mechanism of action and side effects of these immunosuppressive agents used more commonly today are described below, followed by an overview of general principles of therapeutic drug monitoring and concluding with brief information about monitoring of individual immunosuppressive agents as well as a brief description of future trends in immunosuppression therapy.