1. [原著]Increased plasma tacrolimus concentration after single intravenous administration of voriconazole : a case of drug–drug interaction
- Author
-
Shiohira, Hideo, Yamada, Satoshi, Uehara, Hitoshi, Hokama, Nobuo, Ueda, Shinichiro, Department of Hospital Pharmacy, Faculty of Medicine, University of the Ryukyus, and Department of Clinical Pharmacology & Therapeutics, Faculty of Medicine, University of the Ryukyus
- Subjects
CYP3A4/5 ,surgical procedures, operative ,therapeutic drug monitoring ,voriconazole ,chemical and pharmacologic phenomena ,drug–drug interaction ,tacrolimus - Abstract
Tacrolimus, as one of cytochrome P450 (CYP) 4/5 substrates is known to have many drug–drug interactions. Metabolism of tacrolimus is inhibited by many drugs, such as the azole antifungal agents due to their effects on CYP 3A4/5. Implementation of therapeutic drug monitoring is commended during tacrolimus treatment for maintaining optimal plasma concentration levels, and to avoid its toxicity. We herein report a case of a 58-year-old female patient with lupus nephritis whose plasma concentration of orally ministered tacrolimus increased after a single administration of 300 mg voriconazole for suspected Aspergillus infection. Our observations were the result of therapeutic drug monitoring before the second administration of voriconazole. Although tacrolimus dose did not vary, the plasma tacrolimus concentration was markedly increased and concentration dose ratio was 2.1 fold more than prior to voriconazole treatment. This case suggests that even after a single intravenous administration of voriconazole, the plasma concentration of tacrolimus may increase. Dose optimization of tacrolimus by therapeutic drug monitoring soon after the first dose of voriconazole is therefore warranted to minimize the risk of tacrolimus toxicity.
- Published
- 2014