1. Pharmacokinetics, Pharmacodynamics, and Safety of Lisinopril in Pediatric Kidney Transplant Patients: Implications for Starting Dose Selection.
- Author
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Trachtman, H, Frymoyer, A, Lewandowski, A, Greenbaum, LA, Feig, DI, Gipson, DS, Warady, BA, Goebel, JW, Schwartz, GJ, Lewis, K, Anand, R, and Patel, UD
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PHARMACOKINETICS ,PHARMACODYNAMICS ,LISINOPRIL ,KIDNEY transplantation ,PEDIATRIC nephrology ,GLOMERULAR filtration rate ,BLOOD pressure - Abstract
Hypertension in pediatric kidney transplant recipients contributes to long-term graft loss, yet treatment options-including angiotensin-converting enzyme inhibitors-are poorly characterized in this vulnerable population. We conducted a multicenter, open-label pharmacokinetic (PK) study of daily oral lisinopril in 22 children (ages 7-17 years) with stable kidney transplant function. Standard noncompartmental PK analyses were performed at steady state. Effects on blood pressure were examined in lisinopril-naïve patients ( n = 13). Oral clearance declined in proportion to underlying kidney function; however, in patients with low estimated glomerular filtration rate (30-59 ml/min per 1.73m
2 ), exposure (standardized to 0.1 mg/kg/day dose) was within the range reported previously in children without a kidney transplant. In lisinopril-naïve patients, 85% and 77% had a ≥ 6 mmHg reduction in systolic and diastolic blood pressure, respectively. Lisinopril was well tolerated. Our study provides initial insight on lisinopril use in children with a kidney transplant, including starting dose considerations. [ABSTRACT FROM AUTHOR]- Published
- 2015
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