title: Interaction between tacrolimus and intravenous nicardipine in the treatment of post-kidney transplant hypertension at pediatric hospitals.
abstract: TAC is commonly prescribed in KTX recipients, though overexposure can be nephrotoxic. CIVN, used to treat post-KTX hypertension, may inhibit TAC metabolism resulting in overexposure and potential toxicity. We present two case reports and analysis of 2068 KTXs from the PHIS to characterize post-KTX intravenous anti-hypertensive use and to determine whether CIVN in TAC-treated patients would predict "immunosuppressive drug causing adverse effects in therapeutic use" (E-code E9331). CIVN was ordered in 11% of KTXs and prescribing increased from 6.2% in 2003 to 10.3% in 2008 (p=0.003, Mantel-Haenszel chi-square test). AEI were reported in 7.1% of TAC-treated patients with CIVN orders compared to 3% of those without (p=0.003, chi-square test). In univariate analysis using GEEs, AEI were twofold more likely in patients with CIVN orders than patients without (AOR 2.1, 95% CI 1.03-4.17) and threefold more likely than patients with orders for other continuous intravenous anti-hypertensives (AOR 3.2, 95% CI 1.09-9.08). In multivariate analysis, only CIVN significantly predicted AEI (AOR 2.8, 95% CI 1.29-6.04). Thus, until clinical studies to fully characterize this interaction are completed, CIVN should be used with caution in TAC-treated individuals.
authors.affiliation: Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, James M. Anderson Center for Health Systems Excellence, Cincinnati, OH 45229, USA. david.hooper@cchmc.org
authors.forename: David K
authors.initials: DK
authors.lastname: Hooper
authors.forename: Adam C
authors.initials: AC
authors.lastname: Carle
authors.forename: Joseph
authors.initials: J
authors.lastname: Schuchter
authors.forename: Jens
authors.initials: J
authors.lastname: Goebel
mesh_terms: D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D009529:Nicardipine / Q000627:therapeutic use*; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D007166:Immunosuppressive Agents; D009529:Nicardipine; D016559:Tacrolimus