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Related Experiment Videos

Severe prolonged tacrolimus overdose with minimal consequences.

Laura L Hardwick1, Thomas D Batiuk

  • 1Department of Pharmacy, Indiana University Hospital, Clarian Health Partners, Indianapolis, USA. Lhardwic@clarian.org

Pharmacotherapy
|August 14, 2002
PubMed
Summary

A kidney transplant patient experienced a significant tacrolimus overdose but showed minimal toxicity. This case highlights the need for careful dosing education and monitoring for tacrolimus therapy.

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Clinical transplantation·2002

Area of Science:

  • Nephrology
  • Pharmacology
  • Transplantation

Background:

  • Tacrolimus is a crucial immunosuppressant following kidney transplantation.
  • End-stage renal disease and diabetes mellitus are common comorbidities in transplant recipients.
  • Accurate tacrolimus dosing is vital to balance efficacy and toxicity.

Observation:

  • A 59-year-old male kidney transplant recipient inadvertently received a tenfold increase in his daily tacrolimus dose.
  • This overdose led to persistently high trough blood levels (>90 ng/ml) for over a week.
  • The patient presented with minimal signs and symptoms of tacrolimus toxicity despite the prolonged supra-therapeutic levels.

Findings:

  • Despite a substantial tacrolimus overdose, the patient exhibited an unexpected tolerance to its toxic effects.

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  • Commonly reported adverse events like nephrotoxicity, nausea, and tremors were notably absent or minimal.
  • This case suggests potential individual variability in tacrolimus metabolism or toxicity thresholds.

    • Implications:

    • Reinforces the critical need for patient and healthcare provider education on tacrolimus dosing accuracy and potential drug interactions.
    • Emphasizes the importance of close therapeutic drug monitoring to prevent and manage tacrolimus-related adverse events.
    • Suggests further investigation into factors influencing individual patient responses to tacrolimus overdose scenarios.