Shah Aaisha, Nasrullah Adeel, Butt Muhammad Ali, Young Meilin
Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA.
Eur J Case Rep Intern Med. 2022 Sep 16;9(9):003528. doi: 10.12890/2022_003528. eCollection 2022.
Tacrolimus is commonly used as a prophylactic against acute rejection in transplant patients. Tacrolimus toxicity has numerous presentations that have been well documented in the literature and can be induced by a wide variety of agents. We present a novel case of tacrolimus toxicity in a cardiac transplant patient induced by outpatient treatment for COVID-19 pneumonia with ritonavir-nirmatrelvir, which was successfully treated with phenytoin therapy.
Ritonavir-nirmatrelvir is a newly approved antiviral therapy for COVID-19 to prevent hospitalization and is increasingly prescribed in the outpatient setting.Thorough assessment of drug interactions prior to starting ritonavir-nirmatrelvir can prevent tacrolimus toxicity in patients with solid organ transplants.Phenytoin increases the metabolism of tacrolimus and can be safely utilized to treat tacrolimus toxicity.
他克莫司常用于预防移植患者的急性排斥反应。他克莫司毒性有多种表现，文献中有充分记载，且可由多种药物诱发。我们报告了一例心脏移植患者因门诊使用利托那韦 - 奈玛特韦治疗新冠病毒肺炎而引发他克莫司毒性的新病例，该病例通过苯妥英治疗成功治愈。
利托那韦 - 奈玛特韦是一种新批准的用于预防新冠病毒肺炎住院的抗病毒疗法，在门诊环境中开具的处方越来越多。在开始使用利托那韦 - 奈玛特韦之前对药物相互作用进行全面评估，可预防实体器官移植患者出现他克莫司毒性。苯妥英可增加他克莫司的代谢，可安全用于治疗他克莫司毒性。
