Nayeri A, Wu S, Adams E, Tanner C, Meshman J, Saini I, Reid W
Department of Medicine, University of California, Los Angeles, California.
Department of Medicine, University of California, Los Angeles, California.
Transplant Proc. 2017 Jan-Feb;49(1):198-200. doi: 10.1016/j.transproceed.2016.11.029.
Tacrolimus, also known as FK-506, is a potent immunosuppressant agent with a host of drug-drug and food-drug interactions. We present the first case of a probable food-drug interaction between the herb turmeric and tacrolimus leading to acute calcineurin inhibitor nephrotoxicity. A 56-year-old man with a history of orthotopic liver transplantation presented to the emergency department from the clinic with worsening edema in the setting of an elevated creatinine level of 4.2 mg/dL. Before the current presentation, the patient had been recently discharged on a previously tolerated low-dose regimen of tacrolimus with a whole-blood tacrolimus level within the desired range. Tacrolimus level on the day of re-hospitalization was elevated to 29.9 ng/mL in the absence of any changes to the patient's medication regimen. On further prompting, the patient identified recent high-dose intake of turmeric with his food. Tacrolimus was held from the patient's medication regimen, and he was discharged on hospital day 4 with objective evidence of improving renal function. Our report builds on the previous studies that described the effects of turmeric or its active ingredient on the pharmacokinetics of tacrolimus. The appropriate reconciliation of herbal agents such as turmeric can be worthwhile in patients with unexplained changes in tacrolimus levels.
他克莫司，也被称为FK - 506，是一种强效免疫抑制剂，存在大量药物与药物以及食物与药物之间的相互作用。我们报告首例姜黄这种草药与他克莫司之间可能存在的食物与药物相互作用，该相互作用导致了急性钙调神经磷酸酶抑制剂肾毒性。一名有原位肝移植病史的56岁男性从门诊被送往急诊科，当时肌酐水平升高至4.2mg/dL，同时水肿加重。在此次就诊前，患者近期出院时服用的是之前耐受的低剂量他克莫司方案，全血他克莫司水平在期望范围内。再次住院当天，在患者用药方案未作任何改变的情况下，他克莫司水平升至29.9ng/mL。经进一步询问，患者确认近期在饮食中大量摄入了姜黄。他克莫司从患者用药方案中停用，患者于住院第4天出院，此时肾功能改善有客观证据。我们的报告基于之前描述姜黄或其活性成分对他克莫司药代动力学影响的研究。对于他克莫司水平出现不明变化的患者，对姜黄等草药制剂进行适当的核对可能是有价值的。
