Effect of isavuconazole on the concentration of tacrolimus in a patient with genotype CYP3A5*1/*3: a case report
Abstract Background Azole antifungals are the standard treatment for pulmonary mycosis, which may develop during long-term immunotherapy for kidney transplant. Isavuconazole (ISCZ) is a cytochrome P450 (CYP) 3 A inhibitor that has a risk of interacting with the immunosuppressive drug tacrolimus (TAC...
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BMC
2025-03-01
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| Series: | Journal of Pharmaceutical Health Care and Sciences |
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| Online Access: | https://doi.org/10.1186/s40780-025-00427-4 |
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| author | Hayato Yokota Yumiko Akamine Harumi Hatakeyama Hideaki Kagaya Sho Sakamoto Mitsuru Saito Masahide Takeda Kazuhiro Sato Katsutoshi Nakayama Masafumi Kikuchi |
| author_facet | Hayato Yokota Yumiko Akamine Harumi Hatakeyama Hideaki Kagaya Sho Sakamoto Mitsuru Saito Masahide Takeda Kazuhiro Sato Katsutoshi Nakayama Masafumi Kikuchi |
| author_sort | Hayato Yokota |
| collection | DOAJ |
| description | Abstract Background Azole antifungals are the standard treatment for pulmonary mycosis, which may develop during long-term immunotherapy for kidney transplant. Isavuconazole (ISCZ) is a cytochrome P450 (CYP) 3 A inhibitor that has a risk of interacting with the immunosuppressive drug tacrolimus (TAC). We report a case of simple pulmonary aspergilloma with renal dysfunction due to increased trough levels of TAC after ISCZ coadministration. Case presentation A male in his 60s was treated with TAC 3.0 mg/day orally to prevent graft rejection after kidney transplantation. He received a loading dose of ISCZ 600 mg/day orally for two days, followed by a maintenance dose of 200 mg/day for simple pulmonary aspergilloma. The TAC trough concentration increased markedly from 2.4 to 9.9 ng/mL on day 6 after coadministration. The creatinine level increased from 0.70 to 1.08 mg/dL, suggesting renal dysfunction due to TAC. Subsequently, the TAC dosage was reduced, leading to a decreased blood TAC concentration and improved renal function. The patient’s genotype was CYP3A5*1/*3. Conclusions In the early stages of ISCZ treatment, the blood TAC concentration is higher, and CYP3A5 polymorphisms may partially explain the extent of this interaction. We recommend more careful monitoring of TAC and serum creatinine levels for approximately one week after ISCZ administration. |
| format | Article |
| id | doaj-art-226684c6b4a142c8b87fef920e1c3e53 |
| institution | DOAJ |
| issn | 2055-0294 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Pharmaceutical Health Care and Sciences |
| spelling | doaj-art-226684c6b4a142c8b87fef920e1c3e532025-08-20T02:56:21ZengBMCJournal of Pharmaceutical Health Care and Sciences2055-02942025-03-011111610.1186/s40780-025-00427-4Effect of isavuconazole on the concentration of tacrolimus in a patient with genotype CYP3A5*1/*3: a case reportHayato Yokota0Yumiko Akamine1Harumi Hatakeyama2Hideaki Kagaya3Sho Sakamoto4Mitsuru Saito5Masahide Takeda6Kazuhiro Sato7Katsutoshi Nakayama8Masafumi Kikuchi9Department of Pharmacy, Akita University HospitalDepartment of Pharmacy, Akita University HospitalDepartment of Pharmacy, Akita University HospitalDepartment of Pharmacy, Akita University HospitalDepartment of Respiratory Medicine, Akita University Graduate School of MedicineDepartment of Urology, Akita University Graduate School of MedicineDepartment of Respiratory Medicine, Akita University Graduate School of MedicineDepartment of Respiratory Medicine, Akita University Graduate School of MedicineDepartment of Respiratory Medicine, Akita University Graduate School of MedicineDepartment of Pharmacy, Akita University HospitalAbstract Background Azole antifungals are the standard treatment for pulmonary mycosis, which may develop during long-term immunotherapy for kidney transplant. Isavuconazole (ISCZ) is a cytochrome P450 (CYP) 3 A inhibitor that has a risk of interacting with the immunosuppressive drug tacrolimus (TAC). We report a case of simple pulmonary aspergilloma with renal dysfunction due to increased trough levels of TAC after ISCZ coadministration. Case presentation A male in his 60s was treated with TAC 3.0 mg/day orally to prevent graft rejection after kidney transplantation. He received a loading dose of ISCZ 600 mg/day orally for two days, followed by a maintenance dose of 200 mg/day for simple pulmonary aspergilloma. The TAC trough concentration increased markedly from 2.4 to 9.9 ng/mL on day 6 after coadministration. The creatinine level increased from 0.70 to 1.08 mg/dL, suggesting renal dysfunction due to TAC. Subsequently, the TAC dosage was reduced, leading to a decreased blood TAC concentration and improved renal function. The patient’s genotype was CYP3A5*1/*3. Conclusions In the early stages of ISCZ treatment, the blood TAC concentration is higher, and CYP3A5 polymorphisms may partially explain the extent of this interaction. We recommend more careful monitoring of TAC and serum creatinine levels for approximately one week after ISCZ administration.https://doi.org/10.1186/s40780-025-00427-4CYP3A5Drug–drug interactionsIsavuconazoleTacrolimusTherapeutic drug monitoring |
| spellingShingle | Hayato Yokota Yumiko Akamine Harumi Hatakeyama Hideaki Kagaya Sho Sakamoto Mitsuru Saito Masahide Takeda Kazuhiro Sato Katsutoshi Nakayama Masafumi Kikuchi Effect of isavuconazole on the concentration of tacrolimus in a patient with genotype CYP3A5*1/*3: a case report Journal of Pharmaceutical Health Care and Sciences CYP3A5 Drug–drug interactions Isavuconazole Tacrolimus Therapeutic drug monitoring |
| title | Effect of isavuconazole on the concentration of tacrolimus in a patient with genotype CYP3A5*1/*3: a case report |
| title_full | Effect of isavuconazole on the concentration of tacrolimus in a patient with genotype CYP3A5*1/*3: a case report |
| title_fullStr | Effect of isavuconazole on the concentration of tacrolimus in a patient with genotype CYP3A5*1/*3: a case report |
| title_full_unstemmed | Effect of isavuconazole on the concentration of tacrolimus in a patient with genotype CYP3A5*1/*3: a case report |
| title_short | Effect of isavuconazole on the concentration of tacrolimus in a patient with genotype CYP3A5*1/*3: a case report |
| title_sort | effect of isavuconazole on the concentration of tacrolimus in a patient with genotype cyp3a5 1 3 a case report |
| topic | CYP3A5 Drug–drug interactions Isavuconazole Tacrolimus Therapeutic drug monitoring |
| url | https://doi.org/10.1186/s40780-025-00427-4 |
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