01 December 2009
Toxic tacrolimus blood levels with rifampin administration in a renal transplant recipient
Mehat Abdel Halim, Torki Al-Otaibi, Osama Gheith, Osama El-Kholy, Khaled Abdel Tawab, Tarek Said, Prasad Nair, M.R.N. NampooryAnn Transplant 2010; 15(1): 57-60 :: ID: 880570
Abstract
Background: Induction of the hepatic and intestinal cytochrome P450-3A4 system and intestinal P-glycoprotein is an unavoidable consequence of rifampin administration which requires substantial increase in tacrolimus dose when given concurrently. Chronic diarrhea is known to precipitate tacrolimus toxicity irrespective of its cause in renal transplant recipients.
Case Report: A 28 years old lady had a second renal transplant when she was 15 years old which is functioning normally. She was maintained on prednisolone, azathioprine, omeprazole and tacrolimus. Tacrolimus was maintained on therapeutic levels (5-7 ng/ml). She developed pyrexia of unknown origin associated with chronic diarrhea. Detailed investigations didn't reach any definite diagnosis. Antituberculous drugs including rifampin were started emperically. During the first four months of antituberculous treatment diarrhea worsened and unexpected high tacrolimus trough blood levels were observed requiring successive dose reduction from 7 mg/day up to 0.5mg every other day with rise of serum creatinine from 100 to 140 umol/l. Tacrolimus was changed to low dose sirolimus and renal function gradually improved to its baseline while still on rifampin treatment.
Conclusions: We conclude that chronic diarrhea may cause toxic tacrolimus blood levels even in presence of rifampin, this would be due to its significant cytochrome P450-3A4 and P-glycoprotein enzyme inhibitory effect.
Keywords: antibiotic rifampicin, Tacrolimus - pharmacokinetics, graft function, Enzyme Induction - drug effects
In Press
04 Aug 2022 : Original article
Long-Term Patency of All-in-One Sleeve Patch Graft Venoplasty in 16 Patients Who Underwent Living Donor Liv...Ann Transplant In Press; DOI: 10.12659/AOT.936888
22 Jul 2022 : Original article
Diagnostic Role of Tumor Markers for Hepatocellular Carcinoma in Liver Transplantation Candidates: An Analy...Ann Transplant In Press; DOI: 10.12659/AOT.936937
22 Jul 2022 : Original article
Development of a Novel Model for Predicting Postoperative Short-Term Outcome in Patients with Hepatitis B-R...Ann Transplant In Press; DOI: 10.12659/AOT.936732
22 Jul 2022 : Original article
Leucine-Rich Alpha-2-Glycoprotein (LRG-1) as a Potential Kidney Injury Marker in Kidney Transplant RecipientsAnn Transplant In Press; DOI: 10.12659/AOT.936751
Most Viewed Current Articles
26 Jan 2022 : Review article
Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Risk Factors and Predictive ModelsDOI :10.12659/AOT.934924
Ann Transplant 2022; 27:e934924
29 Dec 2021 : Original article
Efficacy and Safety of Tacrolimus-Based Maintenance Regimens in De Novo Kidney Transplant Recipients: A Sys...DOI :10.12659/AOT.933588
Ann Transplant 2021; 26:e933588
24 Jul 2020 : Review article
Kidney Transplantation in the Times of COVID-19 – A Literature ReviewDOI :10.12659/AOT.925755
Ann Transplant 2020; 25:e925755
15 Mar 2022 : Case report
Combined Liver, Pancreas-Duodenum, and Kidney Transplantation for Patients with Hepatitis B Cirrhosis, Urem...DOI :10.12659/AOT.935860
Ann Transplant 2022; 27:e935860