Acute renal injury due to combination of tacrolimus and voriconazole
10.3760/cma.j.cn114015-20221011-00936
- VernacularTitle:他克莫司与伏立康唑联用致急性肾损伤
- Author:
Xinliang YANG
1
;
Wei OU
;
Xiaohua XIE
;
Yejun CHEN
Author Information
1. 岳阳市中心医院药学部，岳阳 414000
- Publication Type:Journal Article
- Keywords:
Drug interactions;
Acute kidney injury;
Tacrolimus;
Voriconazole;
Cytochrome P450 enzyme system
- From:
Adverse Drug Reactions Journal
2023;25(9):570-572
- CountryChina
- Language:Chinese
-
Abstract:
A 73-year-old male patient was treated with tacrolimus 2.5 mg twice daily combined with prednisone 5 mg once daily orally for anti-rejection after lung transplantation. Due to pulmonary aspergillus fumigatus infection, the patient received voriconazole 400 mg orally twice daily on the first day and then 200 mg twice daily from the next day. During this period, the patient continued to receive anti- rejection treatments. Three days after the application of voriconazole, the patient developed decreased urine output and fatigue, serum creatinine was 196 μmol/L, and tacrolimus trough concentration was 49.0 μg/L. Acute kidney injury caused by tacrolimus poisoning was considered. Under the monitoring of blood drug concentration, tacrolimus was discontinued intermittently for 3 days, then tacrolimus was reduced to 0.5 mg once daily and voriconazole was reduced to 150 mg twice daily. Seventeen days later, the patient had a 24- hour urine output of 950 ml, serum creatinine of 154 μmol/L, and tacrolimus trough concentration of 7.7 μg/L. Twenty-two days later, his serum creatinine decreased to 142 μmol/L. It was considered that the abnormal increase of tacrolimus blood trough concentration was related to the inhibited metabolism after combined use with voriconazole.
