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Báo cáo y học: "Probable tacrolimus toxicity from tibolone co-administration in a woman: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Probable tacrolimus toxicity from tibolone co-administration in a woman: a case report. | Clark et al. Journal of Medical Case Reports 2010 4 276 http www.jmedicalcasereports.eom content 4 1 276 jAl JOURNALOF medical ÌỤr case REPORTS CASE REPORT Open Access Probable tacrolimus toxicity from tibolone co-administration in a woman a case report Carolyn J Clark Carmel M Hawley David W Mudge Abstract Introduction Tibolone is a synthetic steroid used with increasing frequency to treat symptoms of menopause including patients with solid-organ transplants who are taking concurrent immune suppression. To the best of our knowledge there are no reported drug interactions between tibolone and tacrolimus one of the principal immune suppressants used in kidney transplantation. Case presentation We report the case of a 49-year-old Caucasian woman who had received a kidney transplant and who developed acute kidney injury secondary to tacrolimus toxicity 10 days after starting tibolone therapy. No alternative causes were found. Tibolone is known to be a weak competitive inhibitor of CYP3A4 which is involved in tacrolimus metabolism. Conclusions Despite a careful evaluation no alternative reason was found for the acute kidney injury and her kidney function returned to the previous baseline within several days of cessation of the medication and with no other specific treatment. Using the Drug Interaction Probability Scale we conclude that she experienced a probable drug interaction. We believe that transplant clinicians should utilise frequent therapeutic drug monitoring of tacrolimus in patients starting or stopping tibolone therapy. Introduction Tibolone is a synthetic steroid with estrogenic androgenic and progestagenic properties. It is indicated for relief of the symptoms of menopause in many countries and has been used in Europe for nearly 20 years 1 but is gaining in use elsewhere in the world including Australia. Tibolone use may be increasing following the recent widely-publicised results of the Women s Health Initiative WHI study 2 which has resulted in a .