Marked elevation of blood cyclosporin and tacrolimus levels due to concurrent metronidazole therapy

Herzig, Karen A.; Johnson, DW

doi:10.1093/ndt/14.2.521b

Cited by 28 publications

(13 citation statements)

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“…Patients therefore did not require significantly lower TAC doses to achieve therapeutic trough levels while taking metronidazole. This observation is contrary to what has been reported in prior case reports, which is that metronidazole leads to significantly elevated TAC levels (4,5). However, our findings do support pharmacokinetic studies that suggest metronidazole is not a potent CYP3A4 or Pgp inhibitor, and therefore should not have a significant effect on the pharmacokinetics of TAC (6,7).…”

Section: Discussioncontrasting

confidence: 99%

Effect of metronidazole use on tacrolimus concentrations in transplant patients treated for Clostridium difficile

Early

Park

Dorsch

et al. 2016

Transplant Infectious Dis

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Section: Discussioncontrasting

confidence: 99%

Effect of metronidazole use on tacrolimus concentrations in transplant patients treated for Clostridium difficile

Early

Park

Dorsch

et al. 2016

Transplant Infectious Dis

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“…Furthermore, in a larger study of 13 children, no improvement in overgrowth were seen at the end of a 3‐month period (Aufricht et al 1997). In addition, metronidazole is known to reduce the hepatic metabolism of ciclosporin leading to the potential risk of nephrotoxicity (Herzig & Johnson 1999). Benefits of metronidazole on the gingival tissues may have resulted simply from a change in the subgingival biofilm and an associated reduction in tissue inflammation.…”

Section: Systemic Antibioticsmentioning

confidence: 99%

The management of drug‐induced gingival overgrowth

Mavrogiannis

Ellis

Thomason

et al. 2006

J Clinic Periodontology

118

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DIGO is a common clinical problem that often requires intervention. Non-surgical techniques can limit the occurrence of this unwanted affect, reduce the extent of plaque-induced gingival inflammation and reduce the rate of recurrence. Wherever possible this management strategy should be adopted first. Surgical treatment is often the most reliable option and scalpel gingivectomy remains the treatment of choice. Further investigations are required to develop appropriate management strategies to prevent recurrence of DIGO.

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“…Two cases have been published in which Met addition to the immunosuppressant regimen with Tac caused a threefold increase in Tac concentrations [11,12]. Also, these cases reported a significant increase in sCr, approximately two-fold .…”

Section: Discussionmentioning

confidence: 99%

Interactions between Tacrolimus and Metronidazole in a renal transplant patient

Catic-Djordjevic

Veličković‐Radovanović²,

Stefanović

et al. 2012

Open Medicine

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AbstractWe present a case which reports the occurrence of a potential elevation of Tacrolimus (Tac) plasma levels to toxic values in a renal transplant recipient after adding Metronidazole (Met) to the medication regimen. A 30-year old female, status post living-related renal transplant, who was stabilized on Tac 4.5 mg, twice daily, for 4 months, presented to the clinic with diarrhea. We used Microparticle Enzyme Immunoassay (MEIA) to determine Tac trough concentration (trough concentrations 5–10 ng/ml). After 6 days of Met therapy on 1.5 g/d, Tac trough concentration and serum creatinine (sCr) increased to 20.2 ng/ml and 7.8 mg/dl respectively. Met therapy was discontinued, also one dose of Tac was withheld, while daily dose was decreased to 2 mg/d. Four days after Met discontinuation, Tac concentration dropped to 8.7 ng/ml, sCr to 2.1 mg/dl, warranting Tac dose increase to 3 mg/d. Co-administration of Tac with Met may result in elevated Tac concentrations, possibly leading to tacrolimus nephrotoxicity. Clinicians should be aware of this potential interaction and closely monitor Tac concentration and renal function.

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Marked elevation of blood cyclosporin and tacrolimus levels due to concurrent metronidazole therapy

Cited by 28 publications

References 0 publications

Effect of metronidazole use on tacrolimus concentrations in transplant patients treated for Clostridium difficile

Effect of metronidazole use on tacrolimus concentrations in transplant patients treated for Clostridium difficile

The management of drug‐induced gingival overgrowth

Interactions between Tacrolimus and Metronidazole in a renal transplant patient

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