Acute kidney injury caused by concomitant use of tacrolimus and posaconazole
10.3760/cma.j.cn114015-20210322-00344
- VernacularTitle:他克莫司联用泊沙康唑致急性肾损伤
- Author:
Chunyan NI
1
Author Information
1. 常州市第一人民医院药学部，常州 213000
- Publication Type:Journal Article
- Keywords:
Lung transplantation;
Acute kidney injury;
Tacrolimus;
Posaconazole
- From:
Adverse Drug Reactions Journal
2022;24(3):144-146
- CountryChina
- Language:Chinese
-
Abstract:
A 72-year-old male patient received anti-infectious treatments with piperacillin sodium and tazobactam sodium, moxifloxacin, and posaconazole, and expectorant treatment with acetylcysteine for pulmonary infection after lung transplantation; original antirejection therapy with tacrolimus and mycophenolate mofetil was continued. Before treatments, serum creatinine was 98 μmol/L and blood urea nitrogen was 3.4 μmol/L. On the 5th day of treatments, the trough blood concentration of tacrolimus increased to 22.9 μg/L, serum creatinine increased to 497 μmol/L, and blood urea nitrogen increased to 17.91 mmol/L. During the consultation, the clinical pharmacists learned that the patient used posaconazole and tacrolimus in combination. They also understood that posaconazole could inhibit the activity of liver cytochrome P450 (CYP) 3A4, while tacrolimus was mainly metabolized by CYP3A4 by searching the literature. Then it is considered that the acute kidney injury caused by tacrolimus occurred due to the increase of blood concentration following the simultaneous application of tacrolimus and posaconazole. Clinical pharmacists recommended that posaconazole was replaced by caspofungin and the dose of tacrolimus was reduced. The clinician adopted the above recommendations and the patient was given continuous venous-venous hemofiltration meantime. Eight days later, the patient′s serum creatinine level gradually decreased to 334 μmol/L, blood urea nitrogen was 7.6 mmol/L, and urine volume was 200 ml. Then hemodialysis was performed 3 times a week; 1 month later, the patient′s serum creatinine was 115 μmol/L, and blood urea nitrogen was 7.2 mmol/L.
