Effect of diltiazem on the pharmacokinetics of microemulsion cyclosporine A in renal transplantation.

OBJECTIVE: Diltiazem might be used as a cyclosporine A (CsA)-sparing agent. There is evidence that CsA (C2) level is the best single point blood sampling for monitoring the CsA level. The authors, therefore, studied the effect of diltiazem on the pharmacokinetics (PK) of CsA, including C2, in renal transplant patients. MATERIAL AND METHOD: Twenty-five CsA-treated renal transplant patients, with neither diseases nor agents that alter the PK of CsA, were enrolled in the present study. The PK of CsA was studied in all patients before and 2 weeks after taking diltiazem. RESULTS: The area under the concentration-time curve (AUC) of CsA was obtained by 2 methods, AUC0-4 and AUC0-12. Before taking diltiazem, the correlation (r) between C0 with AUC0-4 and C0 with AUC0-12 were 0.799 and 0.871, respectively (p = 0.01), r between C2 with AUC0-4 and C2 with AUC0-12 were 0.988 and 0.956, respectively (p = 0.01). Time to maximum concentration (Tmax) of CsA was at 1.5 hr (1.5-4.0 hr) [median (range)]. After two weeks of taking diltiazem, r between C0 with AUC0-4 and C0 with AUC0-12 were 0.577 and 0.784, respectively (p = 0.01), r between C2 with AUC0-4 and C2 with AUC0-12 were 0.988 and 0.896, respectively (p = 0.01). Tmax of CsA was at 1.5 hr (1.5-4.0 hr) [median (range)]. The dosage of CsA could be reduced by 25.8% to maintain the same levels of C0 and C2 in the same patients after taking diltiazem. CONCLUSION: Diltiazem slightly altered the correlation between C2 with AUC of CsA. This indicates that C2 is the best single point blood sampling to monitor the therapeutic levels of CsA in renal transplant patients who are taking diltiazem.

Respiratory complication of tsunami victims in Phuket and Phang-Nga.

In the present report the authors describe the clinical and laboratory findings of 26 tsunami victims admitted to the Phuket and the Takua Pa Hospital. Patients were classified into 4 groups of severity. class 1, baseline examination negative (n = 1); class 2, baseline examination positive but mechanical ventilation not needed on admission (n = 15); class 3, mechanical ventilation required on admission (n = 9); class 4, cardiopulmonary arrest (n = 1). On admission, 21/23 patients had fever of > 37.5 C. 3/10 patients had hypernatremia and 7/10 cases had metabolic acidosis. The radiological manifestation varied from focal disease to diffuse infiltrations, either reticulonodular or patchy lesions. There were 3 clinical courses among diffuse diseases: 1) diffuse infiltrations and progression 3 cases 2) diffuse infiltration, early regression followed by progression 2 cases 3) diffuse infiltration and steady regression 5 cases. Late complications comprised of pneumothorax/pneumomediastinum (n = 5) and bacterial pneumonia (n = 18). The authors got culture data in 9 patients, most of them were infected with aerobic gram -ve bacteria and 2 of them were B. pseudomallei. The prognosis in the tsunami related medical illness was favorable. Only 2 patients (7.7%) died in the present study.