1例55岁男性患者肺移植术后口服他克莫司（早2。5 mg、晚2 mg）6个月用以抗排斥反应，他克莫司血药谷浓度维持在8。0~10。0 μg/L。因感染新型冠状病毒接受抗病毒治疗（奈玛特韦/利托那韦300 mg/100 mg口服、2次/d，共用药5 d），此间患者继续抗排斥反应治疗。接受抗病毒治疗第2天，患者他克莫司血药谷浓度升高至>40。0 μg/L，考虑为奈玛特韦/利托那韦与他克莫司相互作用所致，停用他克莫司，继续抗病毒治疗。停用他克莫司8 d且停用奈玛特韦/利托那韦3 d后，患者他克莫司血药谷浓度降至25。7 μg/L；减量服用他克莫司3 d，该药血药谷浓度为8。3 μg/L；按原剂量和频次恢复服用他克莫司13 d，该药血药谷浓度为9。2 μg/L。此后患者的他克莫司血药谷浓度未再出现异常。 A 55-year-old male patient was treated with tacrolimus (2。5 mg in the morning and 2 mg at night) for 6 months after lung transplantation to prevent rejection。 The blood trough concentration of tacrolimus was stable at 8。0-10。0 μg/L。 The patient received antiviral treatment due to corona virus disease 2019 (nirmatrelvir/ritonavir 300 mg/100 mg twice daily orally for a total of 5 days)。 During the antiviral treatment， the patient continued the anti-rejection treatment。 On the second day of antiviral treatment， the patient′s blood trough concentration of tacrolimus increased to >40。0 μg/L， which was considered to be caused by the interaction between nirmatrelvir/ritonavir and tacrolimus。 Tacrolimus was withdrawn and antiviral therapy was continued。 After discontinuation of tacrolimus for 8 days and nirmatrelvir/ritonavir for 3 days， the blood trough concentration of tacrolimus decreased to 25。7 μg/L。 After re-giving tacrolimus at reducing dosage for 3 days， the blood trough concentration of tacrolimus was 8。3 μg/L。 After 13 days of resuming administration of tacrolimus at the original dose and frequency， the patient′s blood trough concentration of tacrolimus was 9。2 μg/L。 Since then， the blood trough concentration of tacrolimus in the patient was not abnormal again。
Increase of trough concentration of tacrolimus induced by combination of nirmatrelvir/ritonavir and tacrolimus
A 55-year-old male patient was treated with tacrolimus (2.5 mg in the morning and 2 mg at night) for 6 months after lung transplantation to prevent rejection. The blood trough concentration of tacrolimus was stable at 8.0-10.0 μg/L. The patient received antiviral treatment due to corona virus disease 2019 (nirmatrelvir/ritonavir 300 mg/100 mg twice daily orally for a total of 5 days). During the antiviral treatment, the patient continued the anti-rejection treatment. On the second day of antiviral treatment, the patient′s blood trough concentration of tacrolimus increased to >40.0 μg/L, which was considered to be caused by the interaction between nirmatrelvir/ritonavir and tacrolimus. Tacrolimus was withdrawn and antiviral therapy was continued. After discontinuation of tacrolimus for 8 days and nirmatrelvir/ritonavir for 3 days, the blood trough concentration of tacrolimus decreased to 25.7 μg/L. After re-giving tacrolimus at reducing dosage for 3 days, the blood trough concentration of tacrolimus was 8.3 μg/L. After 13 days of resuming administration of tacrolimus at the original dose and frequency, the patient′s blood trough concentration of tacrolimus was 9.2 μg/L. Since then, the blood trough concentration of tacrolimus in the patient was not abnormal again.
Lung transplantationImmunosuppressive agentsDrug interactionsTacrolimusTherapeutic drug monitoringRitonavirNirmatrelvir
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