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Interaction between tacrolimus and intravenous nicardipine in the treatment of post‐kidney transplant hypertension at pediatric hospitals
Author(s) -
Hooper David K.,
Carle Adam C.,
Schuchter Joseph,
Goebel Jens
Publication year - 2011
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2010.01417.x
Subject(s) - medicine , nicardipine , tacrolimus , calcineurin , intensive care medicine , kidney transplant , kidney transplantation , kidney , transplantation , blood pressure
Hooper DK, Carle AC, Schuchter J, Goebel J. Interaction between tacrolimus and intravenous nicardipine in the treatment of post‐kidney transplant hypertension at pediatric hospitals.
Pediatr Transplantation 2011: 15:88–95. © 2010 John Wiley & Sons A/S. Abstract: TAC is commonly prescribed in KTX recipients, though overexposure can be nephrotoxic. CIVN, used to treat post‐KTX hypertension, may inhibit TAC metabolism resulting in overexposure and potential toxicity. We present two case reports and analysis of 2068 KTXs from the PHIS to characterize post‐KTX intravenous anti‐hypertensive use and to determine whether CIVN in TAC‐treated patients would predict “immunosuppressive drug causing adverse effects in therapeutic use” (E‐code E9331). CIVN was ordered in 11% of KTXs and prescribing increased from 6.2% in 2003 to 10.3% in 2008 (p = 0.003, Mantel–Haenszel chi‐square test). AEI were reported in 7.1% of TAC‐treated patients with CIVN orders compared to 3% of those without (p = 0.003, chi‐square test). In univariate analysis using GEEs, AEI were twofold more likely in patients with CIVN orders than patients without (AOR 2.1, 95% CI 1.03–4.17) and threefold more likely than patients with orders for other continuous intravenous anti‐hypertensives (AOR 3.2, 95% CI 1.09–9.08). In multivariate analysis, only CIVN significantly predicted AEI (AOR 2.8, 95% CI 1.29–6.04). Thus, until clinical studies to fully characterize this interaction are completed, CIVN should be used with caution in TAC‐treated individuals.