FK 506/fluconazole interaction enhances FK 506 nephrotoxicity.
In a diabetic liver transplant recipient, immunosuppressed with FK 506, a severe digestive moniliasis required treatment with the antifungal imidazole derivative fluconazole. This was followed by a brisk rise in serum creatinine levels, which returned promptly to baseline when this combination was stopped. Serial measurements of FK 506 concentrations in plasma showed excessive areas under the 24 h time-concentration curve and trough levels during the concomitant intake of imidazole antifungals and FK 506. Eighteen months later, this patient presents with normal renal function. Antifungal imidazole derivatives inhibit the P 450 cytochrome enzyme system and may thus decrease the catabolism of FK 506. Meticulous monitoring of FK 506 trough levels and dosage adaptation are compulsory when concomitant treatment with such a drug is unavoidable. The same is true for cyclosporine in auto-immune diabetic patients receiving cyclosporine A.
Assan
R
R
Diabetes Dpt, Hôpital Bichat, Paris, France.
Fredj
G
G
Larger
E
E
Feutren
G
G
Bismuth
H
H
D002940:Circadian Rhythm; D003404:Creatinine / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D004347:Drug Interactions; D005260:Female; D015725:Fluconazole / Q000009:adverse effects*; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000276:immunology*; D008875:Middle Aged; D016559:Tacrolimus / Q000009:adverse effects* / Q000097:blood
D015725:Fluconazole; D003404:Creatinine; D016559:Tacrolimus