journal article Mar 20, 2025

Drug-Drug Interactions Leading to Tacrolimus Toxicity in a Renal Transplant Patient With COVID-19: The Role of Paxlovid and the Mitigating Use of Phenytoin

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References
17
[1]
Jantz, A. S., Patel, S. J., Suki, W. N.. Treatment of acute tacrolimus toxicity with phenytoin in solid organ transplant recipients. Case reports in transplantation. 2013, 375263:1-6. 10.1155/2013/375263 10.1155/2013/375263
[2]
Kwon EJ, Yun GA, Park S, et al.. Treatment of acute tacrolimus toxicity with phenytoin after Paxlovid (nirmatrelvir/ritonavir) administration in a kidney transplant recipient. Kidney Res Clin Pract. 2022, 41:768-70. 10.23876/j.krcp.22.218 10.23876/j.krcp.22.218
[3]
Khorsan R, Mrinalini S . Acute tacrolimus poisoning treated with phenytoin. Proc UCLA Health. 2023, 27:A230515RK.
[4]
Lawson BO, Seth H, Quan D. Phenytoin and rifampin do not decrease levels in acute tacrolimus toxicity. J Investig Med High Impact Case Rep. 2018, 6:2324709618765862. 10.1177/2324709618765862 10.1177/2324709618765862
[5]
Jain AK, Venkataramanan R, Shapiro R, et al.. The interaction between antiretroviral agents and tacrolimus in liver and kidney transplant patients. Liver Transpl. 2002, 8:841-5. 10.1053/jlts.2002.34880 10.1053/jlts.2002.34880
[6]
Renton KW. Alteration of drug biotransformation and elimination during infection and inflammation. Pharmacol Ther. 2001, 92:147-63. 10.1016/s0163-7258(01)00165-6 10.1016/s0163-7258(01)00165-6
[7]
McLaughlin GE, Rossique-Gonzalez M, Gelman B, Kato T. Use of phenobarbital in the management of acute tacrolimus toxicity: a case report. Transplant Proc. 2000, 32:665-8. 10.1016/s0041-1345(00)00996-9 10.1016/s0041-1345(00)00996-9
[8]
Atmar RL, Finch N. New perspectives on antimicrobial agents: molnupiravir and nirmatrelvir/ritonavir for treatment of COVID-19. Antimicrob Agents Chemother. 2022, 66:e0240421. 10.1128/aac.02404-21 10.1128/aac.02404-21
[9]
Marzi M, Vakil MK, Bahmanyar M, Zarenezhad E. Paxlovid: Mechanism of action, synthesis, and in silico study. Biomed Res Int. 2022, 2022:7341493. 10.1155/2022/7341493 10.1155/2022/7341493
[10]
Li J, Wang Y, Solanki K, et al.. Nirmatrelvir exerts distinct antiviral potency against different human coronaviruses. Antiviral Res. 2023, 211:105555. 10.1016/j.antiviral.2023.105555 10.1016/j.antiviral.2023.105555
[11]
Kawase A, Tanaka H, Otori T. Effects of duration of phenytoin administration on mRNA expression of cytochrome P450 and P-glycoprotein in the liver and small intestine of rats. Asian J Pharm Sci. 2016, 11: 662-7. 10.1016/j.ajps.2016.04.003 10.1016/j.ajps.2016.04.003
[12]
Drug Metabolism - The Importance of Cytochrome P450 3A4. (2014). Accessed. 2025: https://www.medsafe.govt.nz/profs/puarticles/march2014drugmetabolismcytochromep4503a4.htm.
[13]
Wiederrecht G, Lam E, Hung S, Martin M, Sigal N. The mechanism of action of FK-506 and cyclosporin A. Ann N Y Acad Sci. 1993, 696:9-19. 10.1111/j.1749-6632.1993.tb17137.x 10.1111/j.1749-6632.1993.tb17137.x
[14]
McDonnell AM, Dang CH. Basic review of the cytochrome p450 system. J Adv Pract Oncol. 2013, 4:263-8. 10.6004/jadpro.2013.4.4.7 10.6004/jadpro.2013.4.4.7
[15]
Halloran PF. Immunosuppressive drugs for kidney transplantation. N Engl J Med. 2004, 351:2715-29. 10.1056/NEJMra033540 10.1056/nejmra033540
[16]
DeVane CL, Donovan JL, Liston HL, Markowitz JS, Cheng KT, Risch SC, Willard L. Comparative CYP3A4 inhibitory effects of venlafaxine, fluoxetine, sertraline, and nefazodone in healthy volunteers. J Clin Psychopharmacol. 2004, 24:4-10. 10.1097/01.jcp.0000104908.75206.26 10.1097/01.jcp.0000104908.75206.26
[17]
Fishbane S, Hirsch JS, Nair V. Special considerations for Paxlovid treatment among transplant recipients with SARS-CoV-2 infection. Am J Kidney Dis. 2022, 79:480-2. 10.1053/j.ajkd.2022.01.001 10.1053/j.ajkd.2022.01.001
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Published
Mar 20, 2025
Cite This Article
Ricardo A Pagan Santini, Vinay Nair, Ilan Berlinrut, et al. (2025). Drug-Drug Interactions Leading to Tacrolimus Toxicity in a Renal Transplant Patient With COVID-19: The Role of Paxlovid and the Mitigating Use of Phenytoin. Cureus. https://doi.org/10.7759/cureus.80902
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