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Effects of voriconazole on tacrolimus metabolism in a kidney transplant recipient
Author(s) -
Capone D.,
Tarantino G.,
Gentile A.,
Sabbatini M.,
Polichetti G.,
Santangelo M.,
Nappi R.,
Ciotola A.,
D’Alessandro V.,
Renda A.,
Basile V.,
Federico S.
Publication year - 2010
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/j.1365-2710.2009.01070.x
Subject(s) - tacrolimus , voriconazole , medicine , drug interaction , pharmacology , immunosuppression , discontinuation , immunosuppressive drug , drug , ketoconazole , kidney transplantation , kidney , transplantation , dermatology , antifungal
Summary Infection occurs frequently in the organ transplant recipients during the post‐transplant period because of immunosuppression. Therefore, prophylactic antimicrobial agents are often used. The azole antifungals, widely prescribed prophylactically, are known to have many drug–drug interactions. This report presents a case of drug–drug interaction between voriconazole and tacrolimus in a kidney transplant recipient. Voriconazole treatment led to a dramatic increase in tacrolimus concentration that required its discontinuation in spite of the manufacturer’s guidelines that recommend a reduction of tacrolimus dosage by one‐third. The present drug–drug interaction can be attributed to a strong inhibitory effect on cytochrome P450‐3A4 activity by voriconazole. When voriconazole and tacrolimus are coadministered, close monitoring of tacrolimus blood levels is recommended as the rule‐of‐thumb reduction of tacrolimus dose by one‐third may not be satisfactory.