Clinically significant drug-drug interaction between tacrolimus and fluconazole in stable renal transplant recipient and literature review.

Abstract:

WHAT IS KNOWN AND OBJECTIVE:Clinical use of fluconazole against fungal infections in renal transplant patients is complicated by the potentially marked and unpredictable drug-drug interactions (DDIs). We report a case of tacrolimus-fluconazole DDI in a stable renal transplant recipient and describe the mechanism, magnitude and duration of this DDI through a literature review. CASE SUMMARY:A 38-year-old woman experienced a 9.1-fold increase in dose-normalized tacrolimus trough level (trough concentration/weight-normalized daily dose) and an 87% decrease in weight-normalized daily dose (daily dose/body weight) in the treatment of documented Candida albicans oesophagitis by fluconazole. After discontinuation of fluconazole for 161 day, a 26% reduction in weight-normalized daily dose was required to maintain therapeutic exposure. WHAT IS NEW AND CONCLUSION:Oral fluconazole has a more significant impact on its drug interactions with tacrolimus than intravenous fluconazole. Gene screening for CYP3A5 6986 A>G and ABCB1 3435 C>T in organ transplant recipients may help in preventing DDI and facilitating tacrolimus dose adjustment.

journal_name

J Clin Pharm Ther

authors

He J,Yu Y,Yin C,Liu H,Zou H,Ma J,Yang W,Liu Y,Zhong L,Chen X

doi

10.1111/jcpt.13075

subject

Has Abstract

pub_date

2020-04-01 00:00:00

pages

264-269

issue

2

eissn

0269-4727

issn

1365-2710

journal_volume

45

pub_type

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