DOI: 10.12890/2022_003528

Paxlovid with Caution: Novel Case of Paxlovid-Induced Tacrolimus Toxicity in a Cardiac Transplant Patients

Authors

  • Aaisha Shah Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
  • Adeel Nasrullah Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA
  • Muhammad Ali Butt Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
  • Meilin Young Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA

adeel.shifa@gmail.com

Keywords

COVID-19, tacrolimus, heart transplantation, Paxlovid, phenytoin

Abstract

Tacrolimus is commonly used as a prophylactic against acute rejection in transplant patients. Tacrolimus toxicity has numerous presentations that have been well documented in the literature and can be induced by a wide variety of agents. We present a novel case of tacrolimus toxicity in a cardiac transplant patient induced by outpatient treatment for COVID-19 pneumonia with ritonavir-nirmatrelvir, which was successfully treated with phenytoin therapy.

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References

  1. Lindenfeld JA, Miller GG, Shakar SF, Zolty R, Lowes BD, Wolfel EE, et al. Drug therapy in the heart transplant recipient: part I: cardiac rejection and immunosuppressive drugs. Circulation 2004;110(24):3734–3740.
  2. Jantz AS, Patel SJ, Suki WN, Knight RJ, Bhimaraj A, Gaber AO. Treatment of acute tacrolimus toxicity with phenytoin in solid organ transplant recipients. Case Rep Transplant 2013;2013:375263.
  3. NIH. COVID-19 Treatment Guidelines. 2022. Available from https://www.covid19treatmentguidelines.nih.gov/
  4. Najjar-Debbiny R, Gronich N, Weber G, Khoury J, Amar M, Stein N, et al. Effectiveness of Paxlovid in reducing severe COVID-19 and mortality in high risk patients. Clin Infect Dis 2022 Jun 2;ciac443. doi: 10.1093/cid/ciac443. Online ahead of print.
  5. University of Liverpool. COVID-19 drug interactions. 2022. Available from https://www.covid19-druginteractions.org/
  6. Sharma A, Wahby KA, Inany M, Lee SJ. Use of phenytoin for treatment of tacrolimus toxicity with superimposed sepsis. BMJ Case Rep 2020 Jul 20;13(7):e234839.
  7. Epps S, Venkata A. Tacrolimus-induced lung injury. Chest 2021;160:A1190.
  8. Christians U, Jacobsen W, Benet LZ, Lampen A. Mechanisms of clinically relevant drug interactions associated with tacrolimus. Clin Pharmacokinet 2002;41:813–851.
  9. Killin L, Hezam A, Anderson KK, Welk B. Advanced medication reconciliation: a systematic review of the impact on medication errors and adverse drug events associated with transitions of care. Jt Comm J Qual Patient Saf 2021;47:438–451.

Published

2022-09-16

Issue

Vol. 9 No. 9 (2022)

Categories

How to Cite

1.
Shah A, Nasrullah A, Butt MA, Young M. Paxlovid with Caution: Novel Case of Paxlovid-Induced Tacrolimus Toxicity in a Cardiac Transplant Patients. EJCRIM [Internet]. 2022 Sep. 16 [cited 2026 Nov. 3];9(9). Available from: https://ejcrim.com/index.php/ejcrim/article/view/3528

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