Fifth Congress of the Catalan SocietyAcute tacrolimus nephrotoxicity in renal transplant patients treated with clarithromycin
Section snippets
Case reports
We present two patients who developed acute nephrotoxicity after administration of a macrolide antibiotic, clarithromycin (CLR). The patients were two females aged 37 (P-1) and 69 (P-2) years old who underwent kidney transplantation 17 (P-1) and 5 months (P-2) earlier. Patient 1 was inmunosuppressed with TCR (4 mg daily), mycophenolate mofetil, and prednisone; patient 2 was inmunosuppressed with TCR (4 mg daily), azathioprine, and prednisone. The graft function was good, with baseline
Discussion
Drug interaction between TCR and CLR in renal transplantation has been previously described in two separate cases.4, 5 This interaction results in an increase of TCR blood levels in may be nephrotoxic in the same way that cyclosporine is. Acute tacrolimus nephrotoxicity is reversible, and it responds well to reduction in the drug dosage.5 In our experience, azithromycin, another macrolide antibiotic, is an alternative drug to CLR because this antibiotic does not interact significantly with TCR,
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Elevated Tacrolimus Levels Associated With Intravenous Azithromycin and Ceftriaxone: A Case Report
2010, Transplantation ProceedingsCitation Excerpt :Use of the Naranjo ADR Probability Scale4 indicates a possible relationship for these two agents as causative elements elevating the drug levels of TAC. Previously published reports of increased TAC levels due to the well-known interaction with other macrolides were attributed to inhibition of the CYP450 3A4 enzymes from erythromycin or clarithromycin.5–7 In these reports, creatinine levels increased simultaneously with the rising TAC levels.
Outcomes Following Macrolide Use in Kidney Transplant Recipients
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