Tacrolimus (FK506) malabsorption: management with fluconazole coadministration
. We report the use of fluconazole to control primary immunosuppressive management with tacrolimus in a 9‐year‐old liver transplant recipient. Progressive increases in the doses of both cyclosporin (up to 20 mg/kg/day) and, subsequently, tacrolimus (up to 60 mg/day) failed to maintain immunosuppress...
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| Veröffentlicht in: | Transplant international 1997-07, Vol.10 (4), p.331-334 |
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| container_title | Transplant international |
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| creator | Dhawan, A. Mowat, A. P. Tredger, J.M. Gonde, C.E. North‐Lewis, P.J. Heaton, N.J. |
| description | . We report the use of fluconazole to control primary immunosuppressive management with tacrolimus in a 9‐year‐old liver transplant recipient. Progressive increases in the doses of both cyclosporin (up to 20 mg/kg/day) and, subsequently, tacrolimus (up to 60 mg/day) failed to maintain immunosuppressive levels of both agents. After excluding poor compliance, drug interactions and analytical problems and identifying poor bioavailability (< 2.6 %) and rapid clearance (4.2 1/h), fluconazole (100 mg/day) was initiated to inhibit tacrolimus metabolism and consistent therapeutic blood levels of tacrolimus were achieved. However, graft function had deteriorated irrevocably and retransplan‐tation was performed. Simultaneous use of tacrolimus (5 mg/day) and fluconazole (100 mg/day) maintained immunosuppression after transplantation. Three weeks later, obstruction of the Roux loop caused deteriorating liver function and tacrolimus blood levels fell. After correction at laparotomy, stabilisation was achieved and discharge was possible on 5 mg tacrolimus b.i.d. plus fluconazole (100 mg). |
| doi_str_mv | 10.1111/j.1432-2277.1997.tb00713.x |
| format | Article |
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P. ; Tredger, J.M. ; Gonde, C.E. ; North‐Lewis, P.J. ; Heaton, N.J.</creator><creatorcontrib>Dhawan, A. ; Mowat, A. P. ; Tredger, J.M. ; Gonde, C.E. ; North‐Lewis, P.J. ; Heaton, N.J.</creatorcontrib><description>. We report the use of fluconazole to control primary immunosuppressive management with tacrolimus in a 9‐year‐old liver transplant recipient. Progressive increases in the doses of both cyclosporin (up to 20 mg/kg/day) and, subsequently, tacrolimus (up to 60 mg/day) failed to maintain immunosuppressive levels of both agents. After excluding poor compliance, drug interactions and analytical problems and identifying poor bioavailability (< 2.6 %) and rapid clearance (4.2 1/h), fluconazole (100 mg/day) was initiated to inhibit tacrolimus metabolism and consistent therapeutic blood levels of tacrolimus were achieved. However, graft function had deteriorated irrevocably and retransplan‐tation was performed. Simultaneous use of tacrolimus (5 mg/day) and fluconazole (100 mg/day) maintained immunosuppression after transplantation. Three weeks later, obstruction of the Roux loop caused deteriorating liver function and tacrolimus blood levels fell. After correction at laparotomy, stabilisation was achieved and discharge was possible on 5 mg tacrolimus b.i.d. plus fluconazole (100 mg).</description><identifier>ISSN: 0934-0874</identifier><identifier>EISSN: 1432-2277</identifier><identifier>DOI: 10.1111/j.1432-2277.1997.tb00713.x</identifier><identifier>PMID: 9249946</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Absorption ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antifungal agents ; Biological and medical sciences ; Child ; fluconazole ; Fluconazole - administration & dosage ; Fluconazole - pharmacology ; fluconazole Fluconazole ; fluconazole Prograf ; Humans ; Immunosuppressive Agents - pharmacokinetics ; Liver Transplantation ; malabsorption ; Male ; Medical sciences ; Pharmacology. 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P.</creatorcontrib><creatorcontrib>Tredger, J.M.</creatorcontrib><creatorcontrib>Gonde, C.E.</creatorcontrib><creatorcontrib>North‐Lewis, P.J.</creatorcontrib><creatorcontrib>Heaton, N.J.</creatorcontrib><title>Tacrolimus (FK506) malabsorption: management with fluconazole coadministration</title><title>Transplant international</title><addtitle>Transpl Int</addtitle><description>. We report the use of fluconazole to control primary immunosuppressive management with tacrolimus in a 9‐year‐old liver transplant recipient. Progressive increases in the doses of both cyclosporin (up to 20 mg/kg/day) and, subsequently, tacrolimus (up to 60 mg/day) failed to maintain immunosuppressive levels of both agents. After excluding poor compliance, drug interactions and analytical problems and identifying poor bioavailability (< 2.6 %) and rapid clearance (4.2 1/h), fluconazole (100 mg/day) was initiated to inhibit tacrolimus metabolism and consistent therapeutic blood levels of tacrolimus were achieved. However, graft function had deteriorated irrevocably and retransplan‐tation was performed. Simultaneous use of tacrolimus (5 mg/day) and fluconazole (100 mg/day) maintained immunosuppression after transplantation. Three weeks later, obstruction of the Roux loop caused deteriorating liver function and tacrolimus blood levels fell. After correction at laparotomy, stabilisation was achieved and discharge was possible on 5 mg tacrolimus b.i.d. plus fluconazole (100 mg).</description><subject>Absorption</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antifungal agents</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>fluconazole</subject><subject>Fluconazole - administration & dosage</subject><subject>Fluconazole - pharmacology</subject><subject>fluconazole Fluconazole</subject><subject>fluconazole Prograf</subject><subject>Humans</subject><subject>Immunosuppressive Agents - pharmacokinetics</subject><subject>Liver Transplantation</subject><subject>malabsorption</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Pharmacology. Drug treatments</subject><subject>Tacrolimus</subject><subject>Tacrolimus - administration & dosage</subject><subject>Tacrolimus - pharmacokinetics</subject><subject>tacrolimus Malabsorption</subject><issn>0934-0874</issn><issn>1432-2277</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVkF1L5DAUhoOsuKO7P0EoyyJ60e7JR5tmLgQZHBVFQWavQ5pJdjOk7di0OO6v35Qpc29uDof3OUnOg9APDBmO59cmw4ySlBDOMywEz_oKgGOa7Y7Q7BB9QTMQlKVQcvYVnYawAQBS5nCCTgRhQrBihp5XSnetd_UQksvlYw7FVVIrr6rQdtvetc08to36Y2rT9Mm76_8m1g-6bdS_1ptEt2pdu8aFvlMj_Q0dW-WD-T7VM_R7ebta3KdPL3cPi5unVBOW4xQXFiquc805h2pd4jwXmgEphNbUxJZZsFAyTIhm1pZGUWurPBJVwcma0jN0sb9327Vvgwm9rF3QxnvVmHYIkgtcMiLKCM73YNwyhM5Yue1crboPiUGOMuVGjsbkaEyOMuUkU-7i8Pn0ylDVZn0YnezF_OeUq6CVt51qtAsHjHBaEg4Ru95j786bj098QK5eHyjF9D-P5ZDO</recordid><startdate>199707</startdate><enddate>199707</enddate><creator>Dhawan, A.</creator><creator>Mowat, A. P.</creator><creator>Tredger, J.M.</creator><creator>Gonde, C.E.</creator><creator>North‐Lewis, P.J.</creator><creator>Heaton, N.J.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell Publishing</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>199707</creationdate><title>Tacrolimus (FK506) malabsorption: management with fluconazole coadministration</title><author>Dhawan, A. ; Mowat, A. P. ; Tredger, J.M. ; Gonde, C.E. ; North‐Lewis, P.J. ; Heaton, N.J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2451-16f0b7c5c7770bd81559c40269cc3e8154f0f084122c4ff8ea3ffb5402b672d33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Absorption</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Antifungal agents</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>fluconazole</topic><topic>Fluconazole - administration & dosage</topic><topic>Fluconazole - pharmacology</topic><topic>fluconazole Fluconazole</topic><topic>fluconazole Prograf</topic><topic>Humans</topic><topic>Immunosuppressive Agents - pharmacokinetics</topic><topic>Liver Transplantation</topic><topic>malabsorption</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Pharmacology. Drug treatments</topic><topic>Tacrolimus</topic><topic>Tacrolimus - administration & dosage</topic><topic>Tacrolimus - pharmacokinetics</topic><topic>tacrolimus Malabsorption</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dhawan, A.</creatorcontrib><creatorcontrib>Mowat, A. P.</creatorcontrib><creatorcontrib>Tredger, J.M.</creatorcontrib><creatorcontrib>Gonde, C.E.</creatorcontrib><creatorcontrib>North‐Lewis, P.J.</creatorcontrib><creatorcontrib>Heaton, N.J.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Transplant international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dhawan, A.</au><au>Mowat, A. P.</au><au>Tredger, J.M.</au><au>Gonde, C.E.</au><au>North‐Lewis, P.J.</au><au>Heaton, N.J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Tacrolimus (FK506) malabsorption: management with fluconazole coadministration</atitle><jtitle>Transplant international</jtitle><addtitle>Transpl Int</addtitle><date>1997-07</date><risdate>1997</risdate><volume>10</volume><issue>4</issue><spage>331</spage><epage>334</epage><pages>331-334</pages><issn>0934-0874</issn><eissn>1432-2277</eissn><abstract>. We report the use of fluconazole to control primary immunosuppressive management with tacrolimus in a 9‐year‐old liver transplant recipient. Progressive increases in the doses of both cyclosporin (up to 20 mg/kg/day) and, subsequently, tacrolimus (up to 60 mg/day) failed to maintain immunosuppressive levels of both agents. After excluding poor compliance, drug interactions and analytical problems and identifying poor bioavailability (< 2.6 %) and rapid clearance (4.2 1/h), fluconazole (100 mg/day) was initiated to inhibit tacrolimus metabolism and consistent therapeutic blood levels of tacrolimus were achieved. However, graft function had deteriorated irrevocably and retransplan‐tation was performed. Simultaneous use of tacrolimus (5 mg/day) and fluconazole (100 mg/day) maintained immunosuppression after transplantation. Three weeks later, obstruction of the Roux loop caused deteriorating liver function and tacrolimus blood levels fell. After correction at laparotomy, stabilisation was achieved and discharge was possible on 5 mg tacrolimus b.i.d. plus fluconazole (100 mg).</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>9249946</pmid><doi>10.1111/j.1432-2277.1997.tb00713.x</doi><tpages>4</tpages></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals; Wiley Online Library Journals Frontfile Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Absorption Antibiotics. Antiinfectious agents. Antiparasitic agents Antifungal agents Biological and medical sciences Child fluconazole Fluconazole - administration & dosage Fluconazole - pharmacology fluconazole Fluconazole fluconazole Prograf Humans Immunosuppressive Agents - pharmacokinetics Liver Transplantation malabsorption Male Medical sciences Pharmacology. Drug treatments Tacrolimus Tacrolimus - administration & dosage Tacrolimus - pharmacokinetics tacrolimus Malabsorption |
| title | Tacrolimus (FK506) malabsorption: management with fluconazole coadministration |
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