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A case of successful contribution of therapeutic drug monitoring of valganciclovir as the prophylaxis against cytomegalovirus infection in a lung transplant recipient

Authors :
Yoshiki Katada
Keisuke Umemura
Shunsaku Nakagawa
Yurie Katsube
Masahiro Tsuda
Satona Tanaka
Hiroshi Date
Miki Nagao
Tomohiro Terada
Source :
Journal of Pharmaceutical Health Care and Sciences, Vol 10, Iss 1, Pp 1-6 (2024)
Publication Year :
2024
Publisher :
BMC, 2024.

Abstract

Abstract Background Ganciclovir and its prodrug, valganciclovir, are first-line agents for cytomegalovirus infection prophylaxis after lung transplantation. Although valganciclovir prophylaxis is known to result in severe leukopenia as an adverse effect, dosage adjustment based on therapeutic drug monitoring (TDM) of ganciclovir concentration is not generally implemented in clinical practice. Case presentation In this report, we describe the case of a female in her fifties after lung transplantation who successfully maintained valganciclovir prophylaxis under TDM with a minimal occurrence of severe leukopenia. Valganciclovir administration was initiated at a conventional dose of 450 mg/day on postoperative day 43 but was reduced to 450 mg/2 days on postoperative day 69 because of a decrease in white blood cell count and an increase in trough ganciclovir concentration. Subsequently, the valganciclovir dose adjustment was switched from label-indicated renal function-guided dosing to TDM-based dosing, targeting a trough level of 300–800 ng/mL. This target range was determined through deliberations with infectious disease specialists and pharmacists based on previously reported data. The TDM-based dose adjustment successfully prevented cytomegalovirus reactivation without causing significant adverse effects. Valganciclovir prophylaxis was completed on postoperative day 256, and the patient was transferred to another hospital for rehabilitation. Conclusions The findings of the present case suggest that TDM-based dosing could be helpful for clinicians in optimizing the prophylactic administration of valganciclovir in patients undergoing lung transplantation.

Details

Language :
English
ISSN :
20550294
Volume :
10
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Journal of Pharmaceutical Health Care and Sciences
Publication Type :
Academic Journal
Accession number :
edsdoj.12c1eed49fe842a9a1744bf99917f87d
Document Type :
article
Full Text :
https://doi.org/10.1186/s40780-024-00352-y