Interaction between tacrolimus and nefazodone in a stable renal transplant recipient

Ali J. Olyaei, Angelo M DeMattos, Douglas J. Norman, William M. Bennett

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Tacrolimus (FK-506) is an important immunosuppressive agent most often given for maintenance immunosuppression to prevent acute cellular organ rejection. A 57-year-old woman with end-stage renal disease presumed secondary to chronic glomerulonephritis underwent a living related renal allograft transplantation. She tolerated the surgery well and was discharged on postoperative day 5. She was stabilized with prednisone, azathioprine, and tacrolimus. Two years after transplantation, nefazodone 50 mg twice/day orally was prescribed due to depression. After 1 week of nefazodone therapy the patient experienced headache, confusion, and 'gray areas' in her vision, without abnormal ophthalmologic findings. Her serum creatinine was elevated to 2.2 mg/dl (baseline 1.5 mg/dl), and trough tacrolimus level was markedly elevated (> 30 ng/ml). Both tacrolimus and nefazodone are metabolized by the cytochrome P450 (CYP) 3A4 system. We suspect that nefazodone inhibits metabolism of tacrolimus. Coadministration of antidepressant agents such as nefazodone, or any other drug that inhibits the CYP3A4 isoenzyme subfamily, should be anticipated to interfere with tacrolimus metabolism. Monitoring blood concentrations of tacrolimus is vital, and appropriate dosage adjustments are required when the two drugs are administered concurrently to avoid serious interactions such as nephrotoxicity and neurotoxicity.

Original languageEnglish (US)
Pages (from-to)1356-1359
Number of pages4
JournalPharmacotherapy
Volume18
Issue number6 I
StatePublished - Nov 1998
Externally publishedYes

Fingerprint

Tacrolimus
Kidney
Cytochrome P-450 CYP3A
Social Adjustment
Confusion
Transplant Recipients
nefazodone
Azathioprine
Immunosuppressive Agents
Glomerulonephritis
Prednisone
Pharmaceutical Preparations
Kidney Transplantation
Immunosuppression
Antidepressive Agents
Isoenzymes
Chronic Kidney Failure
Allografts
Headache
Creatinine

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Olyaei, A. J., DeMattos, A. M., Norman, D. J., & Bennett, W. M. (1998). Interaction between tacrolimus and nefazodone in a stable renal transplant recipient. Pharmacotherapy, 18(6 I), 1356-1359.

Interaction between tacrolimus and nefazodone in a stable renal transplant recipient. / Olyaei, Ali J.; DeMattos, Angelo M; Norman, Douglas J.; Bennett, William M.

In: Pharmacotherapy, Vol. 18, No. 6 I, 11.1998, p. 1356-1359.

Research output: Contribution to journalArticle

Olyaei, AJ, DeMattos, AM, Norman, DJ & Bennett, WM 1998, 'Interaction between tacrolimus and nefazodone in a stable renal transplant recipient', Pharmacotherapy, vol. 18, no. 6 I, pp. 1356-1359.
Olyaei, Ali J. ; DeMattos, Angelo M ; Norman, Douglas J. ; Bennett, William M. / Interaction between tacrolimus and nefazodone in a stable renal transplant recipient. In: Pharmacotherapy. 1998 ; Vol. 18, No. 6 I. pp. 1356-1359.
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