PMID: 11605780Oct 19, 2001Paper

Use of rapamycin in a transplant patient who developed cyclosporin neurotoxicity

Pediatric Nephrology : Journal of the International Pediatric Nephrology Association
C B HodgesR M Jindal

Abstract

We describe the case of a paediatric kidney transplant patient who developed cyclosporin neurotoxicity on day 7 post-transplant. Consequently, her cyclosporin was stopped and she was commenced on rapamycin. Over the next 3 weeks her creatinine remained elevated and she had several episodes of biopsy proven rejection, despite increasing the initial dose of rapamycin by tenfold. Her whole blood rapamycin levels also remained well below the target range of 10-20 ng/ml. On day 38 post-transplant, the decision was made to add tacrolimus to her immunosuppression. At the same time, phenytoin, which had been commenced during her episode of cyclosporin neurotoxicity, was withdrawn. After this point her rapamycin blood levels rapidly increased to within the therapeutic range and she improved clinically. We propose that phenytoin, as a p450 cytochrome enzyme inducer, increased the metabolism of rapamycin in this patient and hence decreased the initial therapeutic effectiveness of this drug.

Citations

May 14, 2003·Transplantation Proceedings·G W NeffA G Tzakis
Feb 8, 2007·Epilepsia·Delchad DaoudAli Gorji
Jul 6, 2005·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Guido FillerUwe Christians
Jun 9, 2004·Clinical Biochemistry·Michael OellerichBurkhard Tönshoff
Sep 12, 2015·Seminars in Nephrology·Girish Mour, Christine Wu
May 15, 2002·Pharmacoepidemiology and Drug Safety
May 17, 2008·Pediatric Transplantation·Guido FillerUwe Christians
Jan 28, 2003·Therapeutic Drug Monitoring·Jonathan A FridellRaman Venkataramanan

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