KP Wellness
10:55 AM - Limited
Tacrolimus
Miscellaneous Dermatologicals
Protopic (Tacrolimus Ointment) / TIER 2
IMMUNOSUPPRESSANT DRUGS
Tacrolimus Anhydrous (Prograf) / TIER 1
เป็นยาในกลุ่ม immunosuppressant ที่มีข้อบ่งใช้คือใช้เพื่อป้องกัน graft rejection ในผู้ป่วยหลังปลูกถ่ายอวัยวะ ยานี้สามารถกดภูมิคุ้มกันของร่างกายทั้งแบบ cell-mediated immunity และ humoral immunity สำหรับกลไกการกด cell-mediated immunity ไม่ทราบแน่ชัด คาดว่าเกิดจากการที่ tacrolimus จับกับ intracellular protein (FKBP-12) เกิดเป็น complex ซึ่งสามารถยับยั้งการทำงานของ calcineurin (phosphatase activity) ส่งผลทำให้มีการยับยั้งการสร้าง interleukin-2 ซึ่งเป็น inflammatory catalyst ที่มีบทบาทสำคัญต่อการเกิด graft rejection
เนื่องจาก tacrolimus ในร่างกายถูกแปรรูปโดยอาศัย enzyme CYP 3A4 ดังนั้น จึงมีโอกาสเกิดdrug interaction ได้สูงเมื่อใช้ร่วมกับยาอื่นที่มีผลต่อการทำงานของ enzyme นี้ เช่น
1.CYP3A4 inhibitors เช่น
a.ยาในกลุ่ม antifungal agents เช่น fluconazole, ketoconazole
b.ยาในกลุ่ม calcium channel blockers เช่น nifedipine, verapamil
c.ยาในกลุ่ม macrolide antibiotics เช่น erythromycin, clarithromycin
d.ยาในกลุ่ม prokinetic drugs เช่น metoclopramide
e.ยาในกลุ่ม protease inhibitors เช่น indinavir,ritonavir
f.ยาในกลุ่ม proton pump inhibitor เช่น omeprazole, lansoprazole
หมายเหตุ: หากมีการใช้ร่วมกับยาดังกล่าวข้างต้นบางชนิด ควรมีการติดตามระดับยา tacrolimus ในกระแสเลือด รวมทั้งติดตามอาการไม่พึงประสงค์ที่อาจเกิดขึ้นจากยา tacrolimus เช่น nephrotoxicity, hyperglycemia, hyperkalemia
2.enzyme CYP3A4 inducers เช่น
a.ยาในกลุ่ม anticonvulsants เช่น carbamazepine, phenytoin
b.ยาในกลุ่ม rifamycins เช่น rifampin, rifabutin
หากมีการใช้ร่วมกับยาดังกล่าวข้างต้น ควรติดตามผลการรักษาอย่างใกล้ชิด เนื่องจากระดับยาในเลือดอาจลดลง และอาจจำเป็นต้องปรับเพิ่มขนาดยา tacrolimus
c.St John’s wort แนะนำให้ผู้ป่วยงดรับประทาน St John’s wort ในระหว่างที่ใช้ยา tacrolimus
http://drug.pharmacy.psu.ac.th/Question.asp?ID=13921&gid=7
http://pharm.swu.ac.th/psi/content/content10_2.11.48/vol_10_no_2_2005_pg210-218_Tacrolimus_Kinetic_Transplant.pdf
เนื่องจาก tacrolimus ในร่างกายถูกแปรรูปโดยอาศัย enzyme CYP 3A4 ดังนั้น จึงมีโอกาสเกิดdrug interaction ได้สูงเมื่อใช้ร่วมกับยาอื่นที่มีผลต่อการทำงานของ enzyme นี้ เช่น
1.CYP3A4 inhibitors เช่น
a.ยาในกลุ่ม antifungal agents เช่น fluconazole, ketoconazole
b.ยาในกลุ่ม calcium channel blockers เช่น nifedipine, verapamil
c.ยาในกลุ่ม macrolide antibiotics เช่น erythromycin, clarithromycin
d.ยาในกลุ่ม prokinetic drugs เช่น metoclopramide
e.ยาในกลุ่ม protease inhibitors เช่น indinavir,ritonavir
f.ยาในกลุ่ม proton pump inhibitor เช่น omeprazole, lansoprazole
หมายเหตุ: หากมีการใช้ร่วมกับยาดังกล่าวข้างต้นบางชนิด ควรมีการติดตามระดับยา tacrolimus ในกระแสเลือด รวมทั้งติดตามอาการไม่พึงประสงค์ที่อาจเกิดขึ้นจากยา tacrolimus เช่น nephrotoxicity, hyperglycemia, hyperkalemia
2.enzyme CYP3A4 inducers เช่น
a.ยาในกลุ่ม anticonvulsants เช่น carbamazepine, phenytoin
b.ยาในกลุ่ม rifamycins เช่น rifampin, rifabutin
หากมีการใช้ร่วมกับยาดังกล่าวข้างต้น ควรติดตามผลการรักษาอย่างใกล้ชิด เนื่องจากระดับยาในเลือดอาจลดลง และอาจจำเป็นต้องปรับเพิ่มขนาดยา tacrolimus
c.St John’s wort แนะนำให้ผู้ป่วยงดรับประทาน St John’s wort ในระหว่างที่ใช้ยา tacrolimus
http://drug.pharmacy.psu.ac.th/Question.asp?ID=13921&gid=7
http://pharm.swu.ac.th/psi/content/content10_2.11.48/vol_10_no_2_2005_pg210-218_Tacrolimus_Kinetic_Transplant.pdf
Juan Carlos Ivancevich
May 11, 2012 - Public
Tacrolimus Ointment 0.03% for Treatment of Refractory Childhood Phlyctenular Keratoconjunctivitis.
Review of Ophthalmology
Feb 3, 2012 - Public
Animal models suggest IV tacrolimus could suppress the development of PVR.
Sebastian M
Mar 20, 2012 - Public
New surgical techniques offer hope for more effective vitiligo treatment
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A US dermatologist has shed light on various surgical methods, which could lead to more successful treatment of vitiligo - a chronic skin condition that causes areas of the skin to become depigmented (or lose pigment).
Vitiligo most often affects the face, elbows, knees, hands and feet, and the condition is more noticeable in people with darker skin tones.
The most common treatments for vitiligo include topical medications and light therapy that can be used in combination to restore pigment.
Now, newer surgical techniques are being introduced that have shown to have a high success rate in restoring pigment to the affected areas.
One of the new surgical techniques includes skin grafting, where normal skin is used as donor tissue and then grafts are surgically transplanted on areas of vitiligo. The new skin grafts start producing pigment.
Patients who are candidates for this procedure must have stable vitiligo, or vitiligo that has not changed for at least six months.
This procedure can be used for patients with limited areas of vitiligo and also in those with more extensive disease. Patients can decide to use grafts on one area of the body (such as the face) and choose another therapy for other areas affected by vitiligo (such as the hands).
Skin grafting has a high success rate – 80 to 90 percent in most patients.
This in-office procedure is not widely used in the United States but is commonly used in other countries (particularly in South America, Europe, Southeast Asia, India and China).
In melanocyte transplants, melanocytes and keratinocytes (the cells of the top layer of skin) are obtained surgically under local anesthesia from the patient and then grown in a culture in the lab overnight.
This therapy is administered in-office and best used in areas of limited vitiligo where the vitiligo has been stable for at least six months.
Melanocyte transplants have a very high success rate of 95 percent.
Maintenance following surgery is another latest technique, where phototherapy often is used after both skin grafting and melanocyte transplants to stimulate cells to make new pigment faster in treated areas.
As far as topical therapies are concerned, results vary from patient to patient and Dr. Halder noted that on average 45 to 50 percent of patients have an acceptable response using topical therapies to restore pigmentation.
The duration of treatment is approximately four to six months, but patients may need maintenance therapy if pigmentation is lost following the course of treatment.
In cases where less than 20 percent of the skin surface is affected by vitiligo, different strengths of topical corticosteroids can be applied to nearly any part of the skin where vitiligo is present, including the face.
However, a weaker concentration may be prescribed for the face, as some concentrations may be too strong.
One of the main side effects of long-term topical corticosteroid use is thinning of the skin. For this reason, this therapy must be monitored carefully in children.
Topical immunomodulators, or calcineurin inhibitors, can regulate the local immune response of the skin. Two therapies used to treat vitiligo are tacrolimus and pimecrolimus.
There are several types of laser and light therapies that can help treat vitiligo, and a few require the patient to be exposed to a controlled dose of ultraviolet (UV) light.
For very extensive vitiligo in which more than 50 percent of the skin surface is affected or if the condition results in facial disfiguration, some patients opt for depigmentation (a form of bleaching the skin) to blend the remaining pigmented skin with areas of vitiligo.
“It is important for anyone who notices any unusual changes in the pigmentation of their skin to see a dermatologist, as vitiligo treatments are more successful the earlier they are started,” said Dr. Halder.
“The newest surgical grafting techniques and transplant procedures hold a lot of promise for successfully treating vitiligo, and I think we’ll see more dermatologists offering these cutting-edge procedures in this country in the future,” Dr. Halder added.
---------------------------------------------------------------------------------------------------------
A US dermatologist has shed light on various surgical methods, which could lead to more successful treatment of vitiligo - a chronic skin condition that causes areas of the skin to become depigmented (or lose pigment).
Vitiligo most often affects the face, elbows, knees, hands and feet, and the condition is more noticeable in people with darker skin tones.
The most common treatments for vitiligo include topical medications and light therapy that can be used in combination to restore pigment.
Now, newer surgical techniques are being introduced that have shown to have a high success rate in restoring pigment to the affected areas.
One of the new surgical techniques includes skin grafting, where normal skin is used as donor tissue and then grafts are surgically transplanted on areas of vitiligo. The new skin grafts start producing pigment.
Patients who are candidates for this procedure must have stable vitiligo, or vitiligo that has not changed for at least six months.
This procedure can be used for patients with limited areas of vitiligo and also in those with more extensive disease. Patients can decide to use grafts on one area of the body (such as the face) and choose another therapy for other areas affected by vitiligo (such as the hands).
Skin grafting has a high success rate – 80 to 90 percent in most patients.
This in-office procedure is not widely used in the United States but is commonly used in other countries (particularly in South America, Europe, Southeast Asia, India and China).
In melanocyte transplants, melanocytes and keratinocytes (the cells of the top layer of skin) are obtained surgically under local anesthesia from the patient and then grown in a culture in the lab overnight.
This therapy is administered in-office and best used in areas of limited vitiligo where the vitiligo has been stable for at least six months.
Melanocyte transplants have a very high success rate of 95 percent.
Maintenance following surgery is another latest technique, where phototherapy often is used after both skin grafting and melanocyte transplants to stimulate cells to make new pigment faster in treated areas.
As far as topical therapies are concerned, results vary from patient to patient and Dr. Halder noted that on average 45 to 50 percent of patients have an acceptable response using topical therapies to restore pigmentation.
The duration of treatment is approximately four to six months, but patients may need maintenance therapy if pigmentation is lost following the course of treatment.
In cases where less than 20 percent of the skin surface is affected by vitiligo, different strengths of topical corticosteroids can be applied to nearly any part of the skin where vitiligo is present, including the face.
However, a weaker concentration may be prescribed for the face, as some concentrations may be too strong.
One of the main side effects of long-term topical corticosteroid use is thinning of the skin. For this reason, this therapy must be monitored carefully in children.
Topical immunomodulators, or calcineurin inhibitors, can regulate the local immune response of the skin. Two therapies used to treat vitiligo are tacrolimus and pimecrolimus.
There are several types of laser and light therapies that can help treat vitiligo, and a few require the patient to be exposed to a controlled dose of ultraviolet (UV) light.
For very extensive vitiligo in which more than 50 percent of the skin surface is affected or if the condition results in facial disfiguration, some patients opt for depigmentation (a form of bleaching the skin) to blend the remaining pigmented skin with areas of vitiligo.
“It is important for anyone who notices any unusual changes in the pigmentation of their skin to see a dermatologist, as vitiligo treatments are more successful the earlier they are started,” said Dr. Halder.
“The newest surgical grafting techniques and transplant procedures hold a lot of promise for successfully treating vitiligo, and I think we’ll see more dermatologists offering these cutting-edge procedures in this country in the future,” Dr. Halder added.
khizer niaziJun 7, 2012
surgery is not solution of vitiligo this is not a local skin disease.This is also enternal condition. why you can remove with surgery.this surgery is like makeup. Not a solution of diseases.
ReplyDeleteGood to know about Tacrolimus drugs with proper detail and valuable which is pretty impressive to see here, keep doing well and you have done good job....coenzyme q10 capsules