CHEST Guidelines-Monitoring-of-Nonsteroidal-Immunosuppressive-Drugs

Monitoring-of-Nonsteroidal-Immunosuppressive-Drugs

Pdf Summary

The document provides comprehensive guidelines for the monitoring and administration of non-steroidal immunosuppressive drugs in lung disease patients and lung transplant recipients. It emphasizes the critical need for adherence to these guidelines to reduce adverse drug reactions while optimizing therapeutic efficacy.

<strong>Anti-TNF-α agents (Adalimumab, Etanercept, Infliximab):</strong> These drugs, used for sarcoidosis and rheumatoid arthritis, necessitate careful monitoring for infections like tuberculosis (TB) due to immune system suppression. Pre-treatment TB screening and continuous monitoring for TB reactivation and other adverse effects such as congestive heart failure are recommended.

<strong>Calcineurin inhibitors (Cyclosporine, Tacrolimus):</strong> Utilized post-transplant, these drugs require blood level monitoring to prevent renal toxicity. Monitoring blood pressure, glucose, lipids, renal function, and complete blood counts (CBC) is essential due to the risk of nephrotoxicity and hyperlipidemia.

<strong>Antilymphocyte antibodies (Alemtuzumab, Antithymocyte globulin):</strong> These require close vigilance for infusion reactions and infections due to severe immune suppression, necessitating regular blood cell count checks.

<strong>Cytotoxic agents (Azathioprine, Cyclophosphamide):</strong> Essential for chronic pulmonary conditions, they demand regular monitoring of liver and bone marrow function due to risks of hepatotoxicity and marrow suppression.

<strong>mTOR inhibitors (Everolimus, Sirolimus):</strong> Used post-transplant, these require monitoring for side effects such as hyperlipidemia and renal dysfunction through blood and lipid level checks.

<strong>Other agents (Chloroquine, Hydroxychloroquine, Imatinib Mesylate):</strong> Employed in inflammatory lung conditions, these have distinct monitoring needs, such as ocular exams for Chloroquine's ocular toxicity and blood monitoring for Imatinib's pulmonary side effects.

Overall, the document stresses a personalized approach to drug monitoring, integrating infection prophylaxis such as Pneumocystis jiroveci pneumonia where appropriate, and careful consideration of drug interactions and potential side effects, including teratogenicity during pregnancy.

Keywords

immunosuppressive drugs

lung disease

lung transplant

anti-TNF-α agents

calcineurin inhibitors

antilymphocyte antibodies

cytotoxic agents

mTOR inhibitors

drug monitoring

adverse effects