title: Interaction between tacrolimus and chloramphenicol in a renal transplant recipient.
abstract: BACKGROUND
  The metabolism of tacrolimus is influenced by several medications when they are given concurrently. We report the interaction between tacrolimus and chloramphenicol in a renal transplant recipient.
  
  
  METHODS
  An adolescent with vancomycin-resistant Enterococcus was given standard doses of chloramphenicol. Tacrolimus trough levels increased, and the dose was adjusted to maintain the target trough level. Pharmacokinetic studies were obtained during chloramphenicol administration and 14 days after its discontinuation.
  
  
  RESULTS
  Toxic levels of tacrolimus were seen on the second day of chloramphenicol administration, requiring an 83% reduction in the tacrolimus dose. The dose-adjusted area under the curve value for tacrolimus was 7.5-fold greater while the patient was on chloramphenicol. These data are consistent with inhibition of tacrolimus clearance by chloramphenicol
  
  
  CONCLUSIONS
  Chloramphenicol interferes with tacrolimus metabolism. Careful monitoring of tacrolimus trough levels during concomitant chloramphenicol therapy is recommended to avoid toxicity.
authors.affiliation: Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, 19104, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Schulman
authors.forename: L M
authors.initials: LM
authors.lastname: Shaw
authors.forename: K
authors.initials: K
authors.lastname: Jabs
authors.forename: M B
authors.initials: MB
authors.lastname: Leonard
authors.forename: K L
authors.initials: KL
authors.lastname: Brayman
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy; D002701:Chloramphenicol / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D016983:Enterococcus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016030:Kidney Transplantation; D010538:Peritonitis / Q000188:drug therapy / Q000382:microbiology; D011183:Postoperative Complications; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D002701:Chloramphenicol; D016559:Tacrolimus