Clarithromycin/erythromycin/tacrolimus interaction
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Haemolytic uraemic syndrome: 2 case reports Two women developed haemolytic uraemic syndrome (HUS) during treatment with tacrolimus with concomitant clarithromycin or erythromycin administration. A 48-year-old woman with bilateral severe emphysema underwent single sequential lung transplantation. Her postoperative period was complicated by reperfusion injury. On day 52, she was changed to tacrolimus 1mg twice daily [route not stated] due to hirsutism. Four months later, she developed a chest infection which was subsequently treated with erythromycin [route and dosage not stated]. On day 120, she was admitted with thrombocytopenia, uraemia, haemolytic anaemia and a trough tacrolimus concentration of 21 ng/mL. HUS was diagnosed; tacrolimus was stopeed and plasmapheresis was performed daily for 8 days, at which point her platelet count had normalised. A 57-year-old woman with A1 antitrypsin deficiency and severe emphysema underwent lung transplantation. Sixteen months later, features of obliterative bronchiolitis were found and she was switched to tacrolimus 3mg twice daily [route not stated]. At 2 years and 4 months posttransplant, she was doing well on tacrolimus 1mg/0.5mg, prednisolone and azathioprine daily. She was readmitted at 2 years and 7 months after transplantation with chest pain and dyspnoea. Right middle lobe consolidation was found, and amoxicillin and clarithromycin [route and dosage not stated] were started for pneumonia. Seven days later, her pneumonia persisted, her renal parameters had deteriorated and acidosis was noted on arterial blood gas analysis; her tacrolimus concentration was 7.0 ng/mL. She was subsequently transferred with suspected underlying rejection and methylprednisolone was started. The following day, she received tinzaparin sodium therapy for pulmonary embolism and dialysis was started for acidosis and hypokalaemia. Her tacrolimus concentration had increased to more than 30 ng/mL, so tacrolimus and azathioprine were withdrawn. Her haemoglobin level and platelet count continued to drop, and a diagnosis of HUS was made 5 days after transfer. Plasmapheresis was performed for 5 days, with subsequent improvement in her clinical condition. Immunosuppressive therapy was switched to mycophenolate mofetil and sirolimus. Parissis H, et al. Dangerous drug interactions leading to hemolytic uremic syndrome following lung transplantation. Journal of Cardiothoracic Surgery 5: 70, 803044327 2010 - Northern Ireland
0114-9954/10/1329-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 27 Nov 2010 No. 1329
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