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Treatment of prolonged tacrolimus toxicity using phenytoin in a haemodialysis patient
Author(s) -
Meaney Calvin J.,
O’Connor Megan,
McGowan Melissa,
Hamid Mohammed,
Su Winnie
Publication year - 2019
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.12829
Subject(s) - tacrolimus , darunavir , ritonavir , phenytoin , toxicity , medicine , pharmacology , drug interaction , therapeutic drug monitoring , encephalopathy , therapeutic index , pharmacokinetics , transplantation , drug , epilepsy , immunology , human immunodeficiency virus (hiv) , psychiatry , antiretroviral therapy , viral load
Summary What is known and objective Treatment of tacrolimus toxicity includes holding tacrolimus and supportive care. The objective is to describe considerations for pharmacologic induction of tacrolimus metabolism. Case description A 52‐year‐old male with a failed renal transplant on chronic haemodialysis developed tacrolimus toxicity due to a drug‐drug interaction with darunavir/ritonavir. Tacrolimus concentrations were >60 ng/mL for 10 days despite holding tacrolimus and darunavir/ritonavir. Development of encephalopathy prompted initiation of phenytoin to induce tacrolimus metabolism. Tacrolimus concentration was <2 ng/mL within 4 days and mental status normalized. What is new and conclusion Phenytoin metabolic induction is a therapeutic option for prolonged tacrolimus toxicity.