Paxlovid–tacrolimus drug–drug interaction caused severe diarrhea that induced combined diabetic ketoacidosis and a hyperglycemic hyperosmolar state in a kidney transplant patient: a case report

Journal of Medical Case Reports

Case Report

Guang Bing Lu¹  Wei Luo²  Yu He²  Mao Gang Wei²  Qun Yi³ 

[1] Department of Critical Care Medicine, Meishan Traditional Chinese Medical Hospital, 620010, Meishan, Sichuan, People’s Republic of China;Department of Respiratory and Critical Care Medicine, The People’s Hospital of Leshan, 614000, Leshan, Sichuan, People’s Republic of China;Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, 610041, Sichuan, Chengdu, People’s Republic of China;Department of Critical Care Medicine, Sichuan Cancer Hospital, 610041, Chengdu, Sichuan, People’s Republic of China;

关键词: Coronavirus disease 2019;    Transplant recipients;    Immunosuppressant;    Paxlovid;    Tacrolimus;    Diabetic ketoacidosis;    Hyperosmolar hyperglycemic state;    Case report;   

DOI  :  10.1186/s13256-023-04135-1

 received in 2023-06-14, accepted in 2023-08-18,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundTransplant recipients are at high risk of coronavirus disease 2019, and a timely supply of antivirals should be prioritized for those patients. Complicated drug‒drug interactions limit the use of Paxlovid (nirmatrelvir/ritonavir) coadministered with tacrolimus. Here, we report a patient with a kidney transplant who received Paxlovid and reduced-dose tacrolimus at the same time and suffered a severe tacrolimus toxicity.Case presentationWe present a 56-year-old man of Han ethnicity with a kidney transplant who suffered from coronavirus disease 2019 twice. For the first infection, the immunosuppressants were substituted by dexamethasone when the patient used Paxlovid, and everything went well. For the second time, tacrolimus at a reduced dose concomitant with Paxlovid caused severe diarrhea, inducing combined diabetic ketoacidosis and a hyperglycemic hyperosmolar state.ConclusionThis case challenges the dose-adjustment strategy of managing drug‒drug interactions. We suggest that tacrolimus should be stopped when Paxlovid is applied and that corticosteroids could be a good substitution.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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