Interaction between nelfinavir and tacrolimus after orthoptic liver transplantation in a patient coinfected with HIV and hepatitis C virus (HCV).
A 49-year old male patient with severe hemophilia A, coinfected with HIV and HCV, who underwent orthoptic liver transplantation because of hepatitis C cirrhosis is presented. We describe a strong interaction between nelfinavir and tacrolimus postoperatively, that caused a reduction of the dose of tacrolimus by a factor 70 compared with normal, to achieve therapeutic blood concentrations and to avoid toxic side effects. We suggest that nelfinavir inhibits the metabolism of tacrolimus because both compounds are well-known substrates for the cytochrome P450 isoenzyme CYP 3A4. The nelfinavir serum concentrations were not affected by the institution of tacrolimus. Although the interaction dramatically changed the tacrolimus dose-concentration relationship, the situation was manageable by frequent monitoring of blood concentrations of tacrolimus.
Schvarcz
R
R
Department of Infect Diseases, Karolinska Institute, Huddinge University Hospital, Sweden.
Rudbeck
G
G
Söderdahl
G
G
Ståhle
L
L
D004347:Drug Interactions; D016903:Drug Monitoring; D015658:HIV Infections / Q000150:complications*; D017320:HIV Protease Inhibitors / Q000097:blood / Q000627:therapeutic use*; D006467:Hemophilia A / Q000150:complications; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D019888:Nelfinavir / Q000097:blood / Q000627:therapeutic use*; D016559:Tacrolimus / Q000097:blood / Q000627:therapeutic use*
D017320:HIV Protease Inhibitors; D007166:Immunosuppressive Agents; D019888:Nelfinavir; D016559:Tacrolimus