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Case Reports
. 2022 May 13;9(7):ofac238.
doi: 10.1093/ofid/ofac238. eCollection 2022 Jul.

Supratherapeutic Tacrolimus Concentrations With Nirmatrelvir/Ritonavir in Solid Organ Transplant Recipients Requiring Hospitalization: A Case Series Using Rifampin for Reversal

Dusten T Rose  1 , Saurin M Gandhi  2 , Rachael A Bedard  1 , Kristin E Mondy  3 , Alexander L Chu  4 , Kelly C Gamble  1 , Amanda T Gee  1 , Monica A Kundra  2 , Amber L Williams  1 , Brian K Lee  5
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Case Reports

Supratherapeutic Tacrolimus Concentrations With Nirmatrelvir/Ritonavir in Solid Organ Transplant Recipients Requiring Hospitalization: A Case Series Using Rifampin for Reversal

Dusten T Rose et al. Open Forum Infect Dis. .

Abstract

Nirmatrelvir/ritonavir was recently granted emergency use authorization for mild to moderate coronavirus disease 2019. Drug-drug interactions between ritonavir and tacrolimus are underappreciated by nontransplant providers. We describe 2 solid organ transplant recipients prescribed nirmatrelvir/ritonavir for outpatient use who developed tacrolimus toxicity requiring hospitalization and were managed with rifampin for toxicity reversal.

Keywords: COVID-19; drug interactions; nirmatrelvir/ritonavir; tacrolimus.

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Figures

Figure 1.
Figure 1.
Time course of medication interactions and tacrolimus and serum creatinine trends. Serum trough tacrolimus and creatinine levels over hospital course for patient 1 (A) and patient 2 (B). The respective tables and graph detail the serum trough tacrolimus (dashed line) and creatinine (solid line) levels in relation to the dose and timing of nirmatrelvir/ritonavir (NIM-RTV), rifampin (RIF), and tacrolimus administration.
See this image and copyright information in PMC

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