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Transplant patient drug switch warning

The ESPRIT (Efficacy and Safety of Prescribing in Transplantation) Group of leading UK transplant clinicians, pharmacists and primary care representatives is calling for greater awareness of the potential risk to transplant patients of an inadvertent change in their immunosuppressive therapy.

This follows the introduction in the UK of Deximune, a new formulation of the immunosuppressant ciclosporin.

Ciclosporin is a valuable drug in helping prevent rejection following organ transplantation but it is a critical dose drug with a narrow therapeutic window. This means that ensuring individual patients receive the right dose is crucial for the drug to be fully effective: too much may risk toxic effects and too little may lead to an increase in the risk of rejection.

Different formulations of ciclosporin are absorbed and metabolised differently in patients and this may lead to different blood concentrations being reached. It is therefore vitally important that patients who have been stabilised and maintained on a particular formulation of ciclosporin are not switched inadvertently between different preparations.

To maintain efficacy and ensure safety when switching ciclosporin brands patients need to be closely monitored for side effects, drug concentrations and transplant function.

Dr Rod Smith, a Reading GP and representative of the ESPRIT Group, said: "GPs and nurses are in a prime position to educate and support patients who have been transplanted. The need to raise awareness of this issue is clear: survey data show that over 80% of GPs are unaware of the BNF recommendation suggesting that ciclosporin should be prescribed by brand.

"This could clearly impact the health of transplant patients and is something the ESPRIT Group want to communicate to all those involved in the ongoing care of transplant patients."

Timothy Statham, from the National Kidney Federation (NKF), states: "The three most valuable assets surrounding a transplant are the donor, the graft itself and the recipient. The protection of all three is paramount. The NKF therefore believes that for Kidney Patients, medicines should only be 'switched' by the prescriber themselves and by no one else."

National Kidney Federation