Pomelo-induced increase in the blood level of tacrolimus in a renal transplant patient.
BACKGROUND
Tacrolimus, an immunosuppressive agent, is widely used in patients after transplantation to prevent allograft rejection. Because tacrolimus has a narrow therapeutic range, it is essential to carefully control the blood level. It has been demonstrated that tacrolimus is metabolized mainly by cytochrome P-450 (CYP) 3A4, and that tacrolimus is a substrate of P-glycoprotein.


METHODS
This article reports a case of considerable increase in the blood level of tacrolimus after the intake of pomelo in a renal transplant recipient.


RESULTS
Pomelo may increase the blood concentration of tacrolimus by inhibiting CYP 3A4, P-glycoprotein, or both.


CONCLUSIONS
Patients taking drugs such as tacrolimus or cyclosporine, which have their kinetics affected by grapefruit juice, should avoid pomelo and other grapefruit-related citrus fruits.
Egashira
Kanoko
K
Graduate School of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Fukuda
Etsuko
E
Onga
Takayuki
T
Yogi
Yasuo
Y
Matsuya
Fukuzou
F
Koyabu
Noriko
N
Ohtani
Hisakazu
H
Sawada
Yasufumi
Y
D000328:Adult; D002957:Citrus / Q000737:chemistry*; D004347:Drug Interactions; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood* / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D010936:Plant Extracts / Q000009:adverse effects*; D016559:Tacrolimus / Q000097:blood* / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D010936:Plant Extracts; D016559:Tacrolimus