Catatonia as a manifestation of tacrolimus-induced neurotoxicity in organ transplant patients: a case series

Treatment-Refractory Mania with Psychosis in a Post-Transplant Patient on Tacrolimus: A Case Report

“…Our patient had underlying hypertension, diabetes mellitus type 2, thyroid dysfunction and a right adrenal adenoma. Interestingly, her tacrolimus levels were at therapeutic levels, but severe neurotoxicity seemed to not be related to tacrolimus levels, similarly as seen in the study by Veroux et al 6 Based on the FK506 consensus reports by Jusko et al 7 and Wong, 8 tacrolimus therapeutic ranges in kidney transplanted patients should be 10-15 µg/L in the first 6 months of treatment; [8][9][10][11][12] µg/L in the following semester; and 5-10 µg/L as maintenance therapy after one year. Bottiger et al 9 reported neurotoxicity in 10% of patients with drug levels between 10 g/ml and 30 g/mL, while this incidence rises up to more than 20% in patients with a level >30 g/ml.…”

“…This molecule can cross the intact blood brain barrier and probably attaches to myelin, which is rich in lipids, permitting tacrolimus to exert a direct toxic effect through nitrous oxide production. 10 Tacrolimus has downstream regulatory effects on both dopaminergic and N-Methyl-Daspartate receptor systems 2,11 which may be another factor. Another postulated hypothesis relates to hypertensive encephalopathy, which corresponds to white matter changes observed in the parietal and occipital lobes.…”

“…Another postulated hypothesis relates to hypertensive encephalopathy, which corresponds to white matter changes observed in the parietal and occipital lobes. 10 There is relatively no literature on treatment of tacrolimusinduced psychosis. Future areas of study should question whether the type of donor, cadaveric vs live, has any contribution to the tacrolimus-induced psychosis.…”

Acute schizophrenia-like psychotic disorder associated with immunosuppressive agent use three years after renal transplantation: a case report

“…4,9,10 Various tacrolimusassociated behavioural abnormalities have been reported: catatonia or akinetic mutism, paranoid and fugue-like states, psychotic symptoms, and mania. 7,[11][12][13][14] To our knowledge, it does appear that there has not been any earlier report of tacrolimus-induced schizophrenia-like disorder.…”

Can Enforced Behavioral Activity in Spinal Cord Injured Rats be considered as Rehabilitation Process to Accentuate Tacrolimus Treated Recovery? A nursing Care Perspective

“…Tacrolimus, a potent calcineurin inhibitor exhibits neuroprotection actions in several experimental models of central nervous system trauma, including stroke and improved neurological recovery following peripheral and spinal cord injuries [2][3][4][5][6]. However, some side effects from oral and intravenous administration of Tacrolimus in clinical case studies have been reported which include nephrotoxicity [7], lung damage [8], various neuropsychiatric problems, neurotoxic effects such as akinetic mutism and catatonic mutism [9,10]. On the contrary, in experimental studies, Tacrolimus improves the functional outcome of spinal cord injury [5,11,12] and has an in vivo neurotrophic action whereby it enhances the rate of axon regeneration leading to more rapid neurological recovery [13][14][15][16].…”