Contribution du pharmacien dans l’optimisation des schémas thérapeutiques chez les greffés rénaux : évaluation des interactions médicamenteuses

Abstract

Introduction : Kidney transplantation is the treatment of choice for end-stage chronic kidney disease (ESCKD), offering significant improvements in quality of life. However, polypharmacy in transplant patients, who are at high risk of drug interactions (DIs), can compromise therapeutic efficacy and increase toxicity. Objective : This study aims to identify the most common drug interactions in kidney transplant recipients, evaluate their pharmacokinetic and clinical consequences, and optimize therapeutic regimens accordingly. Materials and Methods : This is a bibliographic study based on a review of scientific sources (articles, clinical cases, and guidelines) published between 1980 and 2025. Results :Several major drug interactions were identified in our study. Ketoconazole significantly increases cyclosporine exposure, with AUC elevations up to 15-fold, requiring at least a 50% dose reduction. Clarithromycin raises everolimus AUC by up to 11.4 times, while azithromycin is considered a safer alternative due to its minimal metabolic impact. Lopinavir/ritonavir requires a 5–20% cyclosporine dose reduction due to increased drug exposure. Diltiazem raises tacrolimus blood concentrations by over fourfold, necessitating strict dose adjustment. In contrast, phenytoin reduces cyclosporine AUC by approximately 50%, suggesting the need for alternative treatments not metabolized by CYP3A when possible. Rifampicin decreases sirolimus exposure by more than 80%, necessitating a 5.5 to 6-fold increase in dose in transplant patients treated for tuberculosis. These interactions highlight the need for close monitoring and personalized adjustment of treatment regimens in transplant patients. Conclusion : This study confirms that certain drug classes can significantly alter the efficacy and safety of immunosuppressants, leading to clinical consequences ranging from acute rejection to severe toxicity. In this context, the pharmacist’s role—through their expertise in pharmacokinetics and pharmacodynamics—is essential in ensuring therapeutic success