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The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Related Experiment Video

Updated: Jul 2, 2025

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Decrease in Mycophenolic Acid Plasma Level by Sacubitril/Valsartan in a Lupus Nephritis Patient: A Case Report.

Shunsuke Nashimoto1, Masashi Miyamae2, Issei Higuchi2

  • 1Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan.

Case Reports in Nephrology and Dialysis
|February 29, 2024
PubMed
Summary

Sacubitril/valsartan significantly decreased mycophenolic acid levels in a lupus nephritis patient, suggesting a potential drug interaction. Adjusting the sacubitril/valsartan dose restored mycophenolic acid levels, highlighting the need for careful monitoring.

Keywords:
Drug-drug interactionHypertensionLupus nephritisPharmacokineticsSystemic lupus erythematosus

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Area of Science:

  • Pharmacology
  • Nephrology
  • Immunology

Background:

  • Mycophenolate mofetil (MMF) is a key immunosuppressant for lupus nephritis.
  • Lupus nephritis often co-occurs with hypertension, requiring multiple medications.

Observation:

  • A patient with lupus nephritis experienced a significant decrease in mycophenolic acid (MPA) area under the curve (AUC) after initiating sacubitril/valsartan.
  • MPA AUC levels normalized after reducing the sacubitril/valsartan dosage.

Findings:

  • A potential drug interaction between sacubitril/valsartan and MPA was observed, leading to reduced MPA plasma concentrations.
  • Sacubitril may inhibit organic anion transporting polypeptides (OATPs), affecting MPA enterohepatic circulation.

Implications:

  • This interaction may be relevant in lupus nephritis patients with co-existing hypertension.
  • Further studies are needed to confirm this drug interaction and its mechanism.