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Clinically significant drug‐drug interaction between tacrolimus and fluconazole in stable renal transplant recipient and literature review
Author(s) -
He Jiake,
Yu Yang,
Yin Chenglong,
Liu Hailang,
Zou Hua,
Ma Jingsheng,
Yang Wentao,
Liu Ye,
Zhong Lin,
Chen Xijing
Publication year - 2020
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.13075
Subject(s) - fluconazole , tacrolimus , medicine , discontinuation , drug , drug interaction , pharmacology , transplantation , antifungal , dermatology
What is known and objective Clinical use of fluconazole against fungal infections in renal transplant patients is complicated by the potentially marked and unpredictable drug‐drug interactions (DDIs). We report a case of tacrolimus‐fluconazole DDI in a stable renal transplant recipient and describe the mechanism, magnitude and duration of this DDI through a literature review. Case summary A 38‐year‐old woman experienced a 9.1‐fold increase in dose‐normalized tacrolimus trough level (trough concentration/weight‐normalized daily dose) and an 87% decrease in weight‐normalized daily dose (daily dose/body weight) in the treatment of documented Candida albicans oesophagitis by fluconazole. After discontinuation of fluconazole for 161 day, a 26% reduction in weight‐normalized daily dose was required to maintain therapeutic exposure. What is new and conclusion Oral fluconazole has a more significant impact on its drug interactions with tacrolimus than intravenous fluconazole. Gene screening for CYP3A5 6986 A>G and ABCB1 3435 C>T in organ transplant recipients may help in preventing DDI and facilitating tacrolimus dose adjustment.

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