title: Acute drug toxicity related to drinking herbal tea in a kidney transplant recipient.
abstract: Calcineurin and mTOR inhibitors are commonly used immunosuppressive agents with narrow therapeutic range. As the drugs are mainly metabolized by the P450 cytochrome system, the interaction between food and herbs are also commonly seen and affect the drug levels. We present a case of a kidney transplant recipient with toxic therapeutic levels of cyclosporine A and sirolimus due to interaction between the immunosuppressive agents and Chinese herbal tea. Ingredients within the herbal tea were reported to have inhibitory effect on cytochrome CYP3A4 in-vitro studies. Transplant recipients should be alert that there may be potent interaction between the immunosuppressive drugs and herbs resulting in adverse effect on allograft function.
authors.affiliation: Division of Nephrology, Department of Medicine, Queen Mary Hospital , Hong Kong , China.
authors.forename: Lorraine P Y
authors.initials: LP
authors.lastname: Kwan
authors.forename: Maggie M Y
authors.initials: MM
authors.lastname: Mok
authors.forename: Maggie K M
authors.initials: MK
authors.lastname: Ma
authors.forename: Man-Fai
authors.initials: MF
authors.lastname: Lam
mesh_terms: D001628:Beverages / Q000009:adverse effects*; D001682:Biological Availability; D016572:Cyclosporine / Q000009:adverse effects / Q000493:pharmacokinetics*; D051544:Cytochrome P-450 CYP3A; D065692:Cytochrome P-450 CYP3A Inhibitors; D004347:Drug Interactions; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000493:pharmacokinetics*; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000009:adverse effects / Q000493:pharmacokinetics*
chemical_list: D065692:Cytochrome P-450 CYP3A Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human; D020123:Sirolimus