title: Acute tacrolimus overdose and treatment with phenytoin in liver transplant recipients.
abstract: As a potent immunosuppressive agent, Tacrolimus is widely used in organ transplantation. Although complications due to chronic Tacrolimus use are rather well recognized, little is known about acute overdose and its treatment. Phenytoin, an anti-convulsant agent, can induce the Cytochrome P450 enzyme in the liver, which metabolizes Tacrolimus. Therefore, it can be considered as a potential treatment option for acute Tacrolimus toxicity. We hereby report two cases of acute Tacrolimus overdose after Orthotopic Liver Transplantation and the treatment with Phenytoin. Probable mechanisms of metabolism and interactions of these two drugs are discussed and the literature is reviewed.
authors.affiliation: Transplantation Institute, Division of Liver Transplantation, 3300 NW Expressway, Oklahoma City, Oklahoma 73112, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Karasu
authors.forename: A
authors.initials: A
authors.lastname: Gurakar
authors.forename: J
authors.initials: J
authors.lastname: Carlson
authors.forename: S
authors.initials: S
authors.lastname: Pennington
authors.forename: B
authors.initials: B
authors.lastname: Kerwin
authors.forename: H
authors.initials: H
authors.lastname: Wright
authors.forename: B
authors.initials: B
authors.lastname: Nour
authors.forename: A
authors.initials: A
authors.lastname: Sebastian
mesh_terms: D002675:Child, Preschool; D062787:Drug Overdose; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000378:metabolism; D016031:Liver Transplantation / Q000276:immunology; D008875:Middle Aged; D016559:Tacrolimus / Q000009:adverse effects* / Q000378:metabolism
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus