Table 2. Overview of all PDI affecting MPA pharmacokinetics.
| Druga | Evidence per literature review | nb | Managementc |
|---|---|---|---|
| ↓ MPA area under the curve (AUC)d, ↓ efficacy | |||
| Cyclosporine* | HCT [19], MPA clearance ↑ 33% | 58 | 2 |
| Proton pump inhibitors | Solid organ transplant (SOT), population pharmacokinetic (popPK) analysis [32], no effect | ||
| Omeprazole | Healthy volunteer (HV) [33], MPA AUC ↓ 23% | 28 | 2 |
| Pantoprazole | Autoimmune disorders (AID) [34], MPA AUC ↓ 37%; SOT [35], MPA AUC ↓ 27% | 20 | 2 |
| Esomeprazole | Assumed similar to omeprazole [33] | 1 | 2 |
| Lansoprazole | SOT [36], MPA AUC ↓ 25% | 1 | 2 |
| Corticosteroids* | SOT [20, 32, 37], conflicting data | ||
| Prednisone | SOT, conflicting data with no effect [37, 38] or lower MPA exposure [20] | 15 | 3 |
| Methylprednisolone | SOT [20], MPA clearance ↓ 25% | 2 | 3 |
| Antibiotics | SOT, PopPK study [32], no effect | ||
| Metronidazole | HV [21], MPA AUC ↓ 19% | 1 | 3 |
| Amoxicillin/clavulanic acid | SOT, MPA Ctrough ↓ 46% [39]; SOT, case reporte [40] | 1 | 3 |
| Ciprofloxacin | SOT, MPA Ctrough ↓ 46% [39]; HCT, case reporte [41] | 7 | 3 |
| ↑ MPA AUC, ↑ risk for toxicities | |||
| Valproatee | SOT, case report [22] | 1 | 2 |
aHCT medications are astericked; beach PDI was counted once per patient over the entire study period; cORCA [15] classification of drug interactions with 2 (usually avoid combination: use only under special circumstances) and 3 (minimize risk: assess risk and take recommended actions including considering alternatives, circumventing or monitoring); dlevel 2 scientific evidence [14]; elevel 3 scientific evidence [14].