CHEST Guidelines-Monitoring of Nonsteroidal Immunosuppressive Drugs in Patients With Lung Disease and Lung Transplant Recipients

Monitoring of Nonsteroidal Immunosuppressive Drugs in Patients With Lung Disease and Lung Transplant Recipients

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The November 2012 issue of CHEST outlines evidence-based guidelines for the administration and monitoring of nonsteroidal immunosuppressive drugs in lung disease patients and lung transplant recipients. Developed by the American College of Chest Physicians (ACCP), these guidelines focus on improving patient safety by addressing potential adverse effects such as infections, malignancies, and organ-specific toxicities.<br /><br />The document specifies protocols for drug administration and monitoring, emphasizing the need for patient education on potential risks. It covers several drug categories, including anti-TNF agents, calcineurin inhibitors, antilymphocyte antibodies, IL-2 receptor antagonists, and cytotoxic agents, providing specific recommendations for managing side effects. For instance, chest radiographs and tuberculin skin tests are suggested before starting anti-TNF therapy to screen for latent tuberculosis.<br /><br />For calcineurin inhibitors like cyclosporin A and tacrolimus, regular monitoring of blood counts, liver, and kidney functions is recommended due to the risk of nephrotoxicity. The guidelines also address the risks associated with drugs like adalimumab and infliximab, such as cardiovascular conditions, demyelinating diseases, and autoimmune processes. Special caution is advised regarding use during pregnancy to minimize potential risks to the fetus and breastfeeding infants.<br /><br />Detailed guidance is provided for specific drugs, such as Methotrexate, Leflunomide, Mycophenolic Acid Derivatives, mTOR Inhibitors, Chloroquine/Hydroxychloroquine, and Imatinib Mesylate, outlining their respective monitoring requirements. Key recommendations include regular CBC counts, liver and kidney function tests, and infection prophylaxis. The guidelines underscore the importance of personalizing treatment plans and administering careful lab monitoring to prevent adverse effects and optimize long-term outcomes, serving as a key resource for healthcare providers managing these complex drug regimens.

Keywords

nonsteroidal immunosuppressive drugs

lung disease

lung transplant

American College of Chest Physicians

patient safety

adverse effects

calcineurin inhibitors

anti-TNF agents

drug monitoring

personalized treatment