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Unexpected overdose blood concentration of tacrolimus: Keep in mind the role of inflammation
Author(s) -
Bonneville Edouard,
GautierVeyret Elodie,
Ihl Cordelia,
Hilleret MarieNoelle,
Baudrant Magalie,
Fonrose Xavier,
StankeLabesque Françoise
Publication year - 2020
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.14292
Subject(s) - tacrolimus , medicine , trough level , liver transplantation , drug , inflammation , therapeutic drug monitoring , trough (economics) , pharmacology , blood concentration , biomarker , transplantation , immunology , biology , biochemistry , economics , macroeconomics
Tacrolimus is the cornerstone of the therapeutic immunosuppressive strategy in liver transplantation. The inter‐individual and intra‐individual variability of its trough blood concentrations is a surrogated biomarker of allograft rejection. Here we described two cases of patients with liver transplant who exhibited increases of tacrolimus blood trough concentration adjusted on the dose while experiencing acute inflammatory episodes. These case reports highlight the inhibitory effect of acute inflammation on tacrolimus metabolism and show that it accounts for the longitudinal intra‐individual variability of tacrolimus blood concentrations, beyond drug–drug interaction and observance.