Interaction between tacrolimus and chloramphenicol in a renal transplant recipient.
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.
Schulman
S L
SL
Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, 19104, USA.
Shaw
L M
LM
Jabs
K
K
Leonard
M B
MB
Brayman
K L
KL
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
D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D002701:Chloramphenicol; D016559:Tacrolimus