title: Acute Calcineurin Inhibitor Nephrotoxicity Secondary to Turmeric Intake: A Case Report.
abstract: Tacrolimus, also known as FK-506, is a potent immunosuppressant agent with a host of drug-drug and food-drug interactions. We present the first case of a probable food-drug interaction between the herb turmeric and tacrolimus leading to acute calcineurin inhibitor nephrotoxicity. A 56-year-old man with a history of orthotopic liver transplantation presented to the emergency department from the clinic with worsening edema in the setting of an elevated creatinine level of 4.2 mg/dL. Before the current presentation, the patient had been recently discharged on a previously tolerated low-dose regimen of tacrolimus with a whole-blood tacrolimus level within the desired range. Tacrolimus level on the day of re-hospitalization was elevated to 29.9 ng/mL in the absence of any changes to the patient's medication regimen. On further prompting, the patient identified recent high-dose intake of turmeric with his food. Tacrolimus was held from the patient's medication regimen, and he was discharged on hospital day 4 with objective evidence of improving renal function. Our report builds on the previous studies that described the effects of turmeric or its active ingredient on the pharmacokinetics of tacrolimus. The appropriate reconciliation of herbal agents such as turmeric can be worthwhile in patients with unexplained changes in tacrolimus levels.
authors.affiliation: Department of Medicine, University of California, Los Angeles, California. Electronic address: Anayeri@mednet.ucla.edu.
authors.forename: A
authors.initials: A
authors.lastname: Nayeri
authors.affiliation: Department of Medicine, University of California, Los Angeles, California.
authors.forename: S
authors.initials: S
authors.lastname: Wu
authors.affiliation: Department of Medicine, University of California, Los Angeles, California.
authors.forename: E
authors.initials: E
authors.lastname: Adams
authors.affiliation: Department of Medicine, University of California, Los Angeles, California.
authors.forename: C
authors.initials: C
authors.lastname: Tanner
authors.affiliation: Department of Medicine, University of California, Los Angeles, California.
authors.forename: J
authors.initials: J
authors.lastname: Meshman
authors.affiliation: Department of Medicine, University of California, Los Angeles, California.
authors.forename: I
authors.initials: I
authors.lastname: Saini
authors.affiliation: Department of Medicine, University of California, Los Angeles, California.
authors.forename: W
authors.initials: W
authors.lastname: Reid
mesh_terms: D000208:Acute Disease; D065095:Calcineurin Inhibitors / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D030024:Curcuma / Q000009:adverse effects*; D004487:Edema / Q000209:etiology; D018565:Food-Drug Interactions; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced*; D016559:Tacrolimus / Q000009:adverse effects* / Q000097:blood
chemical_list: D065095:Calcineurin Inhibitors; D003404:Creatinine; D016559:Tacrolimus