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Bax K, Tijssen J, Rieder MJ, Filler G. Rapid Resolution of Tacrolimus Intoxication–Induced AKI With a Corticosteroid and Phenytoin. Ann Pharmacother 2014; 48:1525-8. [DOI: 10.1177/1060028014546184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: To report a novel approach to the management of tacrolimus intoxication that leads to rapid normalization of serum tacrolimus concentrations. Case Summary: A 9-year-old female renal transplant recipient developed a severe tacrolimus intoxication as a result of prolonged diarrhea, which resulted in acute kidney injury, severe dehydration, and neurological symptoms. We used a combination of intravenous steroids and intravenous phenytoin to normalize the tacrolimus level from 32 to 5 ng/mL in less than 24 hours, with complete resolution of symptoms and signs. Discussion: Tacrolimus intoxication is a rare event but may result in life-threatening complications. Treatment recommendations beyond holding the drug and enzyme induction with phenytoin or phenobarbital are elusive. This approach leads to a relatively slow normalization of the tacrolimus level over 72 hours. The authors hypothesized that additional induction of the p-glycoprotein through steroids was synergistic. Conclusions: The combination of phenytoin and a corticosteroid may be an effective approach that leads to rapid normalization of severely elevated tacrolimus levels.
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Affiliation(s)
- Kevin Bax
- University of Western Ontario, Department of Paediatrics, London, ON, Canada
- Children’s Hospital, London Health Sciences Centre, London, ON, Canada
| | - Janice Tijssen
- University of Western Ontario, Department of Paediatrics, London, ON, Canada
- Children’s Hospital, London Health Sciences Centre, London, ON, Canada
| | - Michael J. Rieder
- University of Western Ontario, Department of Paediatrics, London, ON, Canada
- Children’s Hospital, London Health Sciences Centre, London, ON, Canada
| | - Guido Filler
- University of Western Ontario, Department of Paediatrics, London, ON, Canada
- Children’s Hospital, London Health Sciences Centre, London, ON, Canada
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