Doligalski Christina Teeter, Liu Esther C, Sammons Chelsea M, Silverman Andrew, Logan Angela Tong
Department of Pharmacy, Tampa General Hospital, Tampa, Florida.
Pharmacotherapy. 2014 Nov;34(11):1209-19. doi: 10.1002/phar.1492. Epub 2014 Sep 24.
Widespread anecdotal use of sublingual tacrolimus administration has arisen, although little literature exists to guide practice. Given the paucity of data, we conducted a survey to evaluate the practice of sublingual tacrolimus administration at transplant centers across the United States and evaluated the literature that is currently available. A 10-question online survey assessing the current state of sublingual tacrolimus use was distributed to pharmacists at transplant centers that each performed more than 100 solid organ transplantations in 2013. In addition, a literature review was performed by searching the PubMed database to identify available evidence for the sublingual administration of tacrolimus. The online survey was completed by 59 (65.6%) of the 90 targeted transplant centers, representing 51.3% of all solid organ transplantations performed in 2013. Sublingual administration of tacrolimus was used in all solid organ transplant populations, with ~67% of lung transplant centers using this route for tacrolimus. The most common dose conversion was 2 mg oral to 1 mg sublingual, with 92% of centers opening oral capsules and administering the contents sublingually. Home use of sublingual administration and use in the pediatric population was uncommon. Seven peer-reviewed reports and one abstract were identified in the literature review. Seven of the eight publications reported favorably on sublingual administration, although no consistent dose conversion or method of administration was elucidated. The majority of the transplant centers surveyed found sublingual tacrolimus a viable alternative when oral administration is unavailable. A large robust prospective evaluation of sublingual administration of tacrolimus is imperative to provide the most effective care to solid organ transplant recipients and to ensure optimal safety for both patients and providers who administer the drug.
尽管指导实践的文献很少，但他克莫司舌下给药已在广泛应用。鉴于数据匮乏，我们进行了一项调查，以评估美国各移植中心他克莫司舌下给药的情况，并对现有文献进行了评估。一项包含10个问题的在线调查，评估他克莫司舌下给药的现状，已分发给2013年各自进行了超过100例实体器官移植的移植中心的药剂师。此外，通过检索PubMed数据库进行文献综述，以确定他克莫司舌下给药的现有证据。90个目标移植中心中有59个（65.6%）完成了在线调查，占2013年所有实体器官移植的51.3%。他克莫司舌下给药应用于所有实体器官移植人群，约67%的肺移植中心使用此途径给予他克莫司。最常见的剂量转换是口服2mg相当于舌下1mg，92%的中心打开口服胶囊并舌下给药其内容物。在家中使用舌下给药以及在儿科人群中的使用并不常见。在文献综述中确定了7篇同行评审报告和1篇摘要。8篇出版物中有7篇对舌下给药给予了肯定评价，尽管未阐明一致的剂量转换或给药方法。大多数接受调查的移植中心发现，当无法口服给药时，他克莫司舌下给药是一种可行的替代方法。迫切需要对他克莫司舌下给药进行大规模、有力的前瞻性评估，以便为实体器官移植受者提供最有效的护理，并确保给药的患者和医护人员的最佳安全。
