免疫抑制薬の中枢毒性モニタリング

Abstract

Cyclosporine-or tacrolimus-induced neurotoxicity was retrospectively evaluated in five patients. Symptoms ranging from mild (tremor, insomnia, visual disturbance) to severe events (convulsion, leukoencephalopathy) were observed. The predisposing risk factors in these patients included hypomagnesemia, liver dysfunction and transient high blood concentrations of the immunosuppressants. Besed on our findings as well as those from other reports, the initial signs and symptoms of immunosuppressant-induced neurotoxicity were as follows ; tremor, headache, anorexia, nausea, vomiting, lethargy, insomnia, anxiety, amnesia, visual disturbance. However, not all of these events correlated with the blood concentrations of the immunosuppressants. The blood cyclosporine concentrations decreased by concomitant use of phenytoin. The blood tacrolimus concentrations varied markedly during the two-week-period after liver transplantation. To prevent patientsfrom developing serious events under immunosuppressant therapy, pharmacists should thus recognize the predisposing risk factors in patients, and carefully monitor the initial signs related to neurotoxicity and the blood concentrations of the patients receiving immunosuppressants.