Effect of Ganciclovir on Pharmacokinetics of Mycophenolic Mofetil, in Kidney Transplant Patients

Mycophenolate mofetil (MMF) is commonly administered concomitantly with ganciclovir for managing transplant recipients who infected with CMV. This study was conducted to evaluate the probable effects of ganciclovir on Mycophenolic acid (MPA) pharmacokinetic.Ten kidney transplant recipients who full field inclusion and exclusion criterias enrolled in this study. The first full profile blood sampling was taken during the combination therapy of gancyclovir and MMF. The second sampling was taken one week after discontinuation of gancyclovir. Serum concentrations of MPA and its glucuronide metabolite (MPAG) were determined by high-performance liquid chromatography (HPLC) method. The pharmacokinetic parameters of MPA were measured, in two conditions, for each patient. There was no significant differencebetween MPA clearance alone and in combination with ganciclovir (28.2±21.9 L/hvs 31.9±21.3 L/h, p=0.207) and also no significant difference was seen between the MPA Area Under the Curve (AUC) in two conditions (43.48±16.27 µg/ml.h vs 39.80±20.18 µg/ml.h, p=0.221). MPAG AUC was increased significantly when the drugs were administrated in combination (957.8±675.2 µg/ml.h vs 1348.6±1095.1µg/ml.h, p=0.036). Also ganciclovir induced entrohepatic recirculation of MPA in two patients. The pharmacokinetic parameter of MPA was not affected by ganciclovir. But ganciclovir increased MPAG AUC and induced enterohepatic recirculation of MPA.