Related Experiment Videos
Tacrolimus (FK506) malabsorption: management with fluconazole coadministration
A Dhawan1, J M Tredger, P J North-Lewis
1Paediatric Liver Services King's College Hospital, London, UK.
Summary
Fluconazole effectively boosted tacrolimus levels in a liver transplant patient with poor drug absorption. This antifungals use helped maintain immunosuppression, even after retransplantation.
Area of Science:
- Pharmacology
- Transplant Medicine
- Clinical Pharmacy
Background:
- Tacrolimus is a key immunosuppressant after liver transplantation.
- Achieving consistent therapeutic drug levels can be challenging due to variable patient factors.
Observation:
- A 9-year-old liver transplant recipient exhibited poor tacrolimus bioavailability and rapid clearance.
- Standard dose adjustments of tacrolimus and cyclosporine failed to achieve target immunosuppression.
Findings:
- Co-administration of fluconazole (100 mg/day) inhibited tacrolimus metabolism, leading to consistent therapeutic blood levels.
- Fluconazole facilitated successful immunosuppression with lower tacrolimus doses post-retransplantation.
Implications:
- Fluconazole can be a valuable adjunct to manage tacrolimus therapy in patients with impaired drug absorption or rapid metabolism.
- This strategy may improve immunosuppressive control and outcomes in challenging liver transplant cases.