Tacrolimus-induced mania in a patient with nephrotic syndrome

Kumar, Alok; Khrime, Dorchhom; Ruhela, Vivek

doi:10.4103/ijp.ijp_710_20

Cited by 1 publication

(2 citation statements)

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“…A recent case report further identified a patient who experienced tacrolimus-induced psychosis at therapeutic levels suggesting that the induced psychosis may not solely depend on neurotoxic blood levels of the immunosuppressant [5]. Another similar report described a patient with nephrotic syndrome who developed tacrolimus-induced mania at therapeutic levels which only resolved after withdrawal of tacrolimus and the addition of antipsychotics [5,6]. The epigenetic influence of medications and their cross implications in familial predispositions has been noted with other psychoactive medications previously.…”

Section: Discussionmentioning

confidence: 87%

“…Withdrawal of the drug has reliably led to the eventual resolution of such symptoms. Some reports have also purported a switch to cyclosporine therapy to further ensure appropriate resolution of neurotoxic side effects [2,6]. A recent case report further identified a patient who experienced tacrolimus-induced psychosis at therapeutic levels suggesting that the induced psychosis may not solely depend on neurotoxic blood levels of the immunosuppressant [5].…”

Section: Discussionmentioning

confidence: 99%

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Descent into Mania: A Case of Tacrolimus-Induced Psychosis

Itani

2023

CCRS

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Background: Tacrolimus has historically been used as an effective immunosuppressant in solid organ transplants. Although it is standard care in most organ transplants, it is accompanied by a vast number of side effects, including headache, fatigue, and even psychosis. The neurotoxic side effects that accompany tacrolimus are usually apparent at supratherapeutic doses and resolve after dose adjustment or discontinuation. Case Presentation: We present a case of a 68-year-old male who sustained tacrolimus-induced mania post- transplant, refractory to both medication tapering and removal. He ultimately required the use of prolonged antipsychotic therapy. Conclusion: This study highlights the necessity for thorough psychiatric evaluations in patients undergoing organ transplantation as well as the continued need for further research and interventions in patients undergoing prolonged immunosuppressive therapy. This report may signify a novel mechanism of dose-independent neurotoxicity secondary to tacrolimus.

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Section: Discussionmentioning

confidence: 87%