Treatment of prolonged tacrolimus toxicity using phenytoin in a haemodialysis patient. (4th March 2019)

• Record Type: Journal Article
• Authors: Meaney, Calvin J.; O'Connor, Megan; McGowan, Melissa; Hamid, Mohammed; Su, Winnie
• Is Part Of: Journal of clinical pharmacy and therapeutics. Volume 44:Number 4(2019)
• Page Start: 640
• Page End: 643
• Publication Date: 2019-03-04
• Subjects: haemodialysis -- phenytoin -- tacrolimus -- toxicity; Clinical pharmacology -- Periodicals; Chemotherapy -- Periodicals; 615
• DOI: 10.1111/jcpt.12829
• Languages: English
• ISSNs: 0269-4727

Abstract

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. Abstract : Tacrolimus toxicity lasting 10 days was successfully treated with phenytoin in this case report. Induction of tacrolimus metabolism is a viable option for treatment of toxicity and may have a quick onset.