Journal of Chinese Pharmaceutical Sciences ›› 2019, Vol. 28 ›› Issue (4): 257-263.DOI: 10.5246/jcps.2019.04.026

• Drug administration and clinical pharmacy column • Previous Articles     Next Articles

Pharmacokinetic interaction between glucocorticoids and tacrolimus after renal transplantation

Hui Yang1, Xiaopeng Hu2, Xiongyong Yang2, Hang Liu2, Liang Ren2, Wei Wang2, Lihong Liu1*, Xiaodong Zhang2*   

  1. 1. Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
    2. Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
  • Received:2018-10-17 Revised:2019-01-05 Online:2019-04-30 Published:2019-03-26
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There is an interaction between tacrolimus (TAC) and glucocorticoids where glucocorticoids is a known CYP3A4 and P-gp inducer. However, the dose of glucocorticoids reported is low but not pulse therapy. We retrospectively studied 63 renal transplant recipients receiving TAC after transplantation. All the patients were classified as 500 mg (POD 13), 30 mg (POD 410), 25 mg (POD 1117), 20 mg (POD 1824), 15 mg (POD 2531), 10 mg (POD 3260) and 10 mg (POD 6190). We recorded daily data for each patient from the day of transplantation until POD 90. There was no difference in TAC blood levels within the 3 months after transplantation in the glucocorticoids groups. However, the average daily dose of TAC was significantly lower by weekly reductions of 5 mg dose. The TAC daily dose was not changed from POD 14, but the blood concentrations of TAC were significantly lower after the glucocorticoid dose was changed from 500 mg to 30 mg. We demonstrated the induction effect of low-dose glucocorticoids on TAC in renal transplant recipients, and found that the high-dose of glucocorticoids might play a role in substrate competition. We proposed that monitoring of the blood concentrations of TAC was needed when the glucocorticoid dose was changed in the patient undergoing renal transplantation.

Key words: Interaction, Tacrolimus, Glucocorticoids, Pharmacokinetic, CYP3A4

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