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Everolimus‐induced nephrotic syndrome precipitated by interaction with voriconazole in a patient with Hodgkin's lymphoma
Author(s) -
Tran P. N.,
PinterBrown L. C.
Publication year - 2017
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/jcpt.12572
Subject(s) - nephrotic syndrome , everolimus , voriconazole , medicine , lymphoma , hodgkin lymphoma , pharmacology , dermatology , antifungal
Summary What is known and objectives Everolimus is a small molecule that inhibits the mammalian target of rapamycin ( mTOR ) and is used for treatment of various solid tumours and renal transplant rejection prophylaxis. Whereas everolimus‐induced proteinuria was previously observed in 3%‐36% renal transplant recipients, nephrotic syndrome was not reported in cancer patients taking everolimus. However, nephrotic syndrome was reported in patients taking sirolimus. Case summary We report the case of a 32‐year‐old female with relapsed Hodgkin's lymphoma who was on everolimus for 5 years and developed nephrotic syndrome about 2 months after initiation of voriconazole. She was on 10 mg everolimus once a day and 200 mg voriconazole twice a day orally. Renal biopsy revealed thrombotic microangiopathic vasculopathy and thin basement membrane nephropathy. Discontinuation of everolimus and voriconazole rapidly improved her nephrotic syndrome. What is new and conclusion We provide in‐depth analysis of the underlying mechanisms of everolimus‐induced nephrotic syndrome and hypothesize that voriconazole likely decreased everolimus metabolism. In the era of targeted therapy for cancer, healthcare providers should be aware of the drug‐drug interaction between everolimus (as well as tyrosine kinase inhibitors) and cytochrome P450 CYP 3A4 inhibitors (ie voriconazole).