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Published ahead of print on February 14, 2007
Clin J Am Soc Nephrol 2: 374-384, 2007
© 2007 American Society of Nephrology
doi: 10.2215/CJN.03791106
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Diagnostic and Therapeutic Corner

Therapeutic Monitoring of Calcineurin Inhibitors for the Nephrologist

Jeffrey Schiff*, Edward Cole*, and Marcelo Cantarovich{dagger}

* Division of Nephrology, University Health Network, Toronto General Hospital, Toronto, Ontario, and {dagger} Multi-Organ Transplant Program, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada

Address correspondence to: Dr. Marcelo Cantarovich, Royal Victoria Hospital, 687 Pine Avenue West, Room R2.58, Montreal, Quebec, Canada, H3A 1A1. Phone: 514-934-1934, ext. 36223; Fax: 514-843-2815; E-mail: marcelo.cantarovich{at}muhc.mcgill.ca

The calcineurin inhibitors (CNI) cyclosporine and tacrolimus remain the backbone of immunosuppression for most kidney transplant recipients. Despite many years of experience, protocols that optimize efficacy with minimal toxicity remain a subject of debate. Nevertheless, studies of the pharmacokinetic properties of the CNI, particularly cyclosporine, have led to improved dosing strategies. The purpose of this article is to review the current understanding of CNI pharmacokinetics and its relevance to proper dosing and monitoring of these medications. This article also reviews the trials that have helped to define the optimal dosages and discusses the effect of adjunctive immunosuppressive agents on CNI pharmacokinetics and dosing.




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