Posttransplant Tacrolimus-Induced Diabetic Ketoacidosis: Review of the Literature

Ammari, Zaid; Pak, Stella; Ruzieh, Mohammed; Dasa, Osama; Tiwari, Abhinav; Jaume, Juan Carlos; Alfonso-Jaume, Maria A.

doi:10.1155/2018/4606491

Cited by 5 publications

(9 citation statements)

References 25 publications

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“…Decreased insulin requirements after completing fluconazole therapy indicate that toxic levels of tacrolimus may cause transient and apparently reversible pancreatic damage [2]. A small study of 20 transplant patients who were given tacrolimus and fluconazole reported a dose related effect of each other.…”

Section: Discussionmentioning

confidence: 99%

“…Most commonly reported side-effects are neurotoxicity and nephrotoxicity [1]. New-onset diabetes is now a well-established and well-studied adverse effect of calcineurin inhibitors, mostly tacrolimus [2]. Azole antifungals are associated with increasing tacrolimus blood levels and occurrences of adverse effects related to tacrolimus toxicity from inhibition of liver cytochrome enzymes and small intestine microsomes [6].…”

Section: Introductionmentioning

confidence: 99%

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Tacrolimus-induced Diabetic Ketoacidosis in a Polymyositis Patient Precipitated by Fluconazole: A Case Report and Review of the Literature

Chaudhary¹,

Kumar²,

Chigurupati³

et al. 2020

AJMCR

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Tacrolimus is a reversible calcineurin inhibitor. It is commonly used as an immunosuppressive drug in the treatment of T cell mediated diseases such as polymyositis, graft rejection in solid organ transplant, graft-versus-host disease in hematopoietic stem cell transplant, and is postulated to have diabetogenic potential. Fluconazole, on the other hand, is frequently prescribed antifungal therapy. Fluconazole increases the serum level of tacrolimus into the supratherapeutic range, thus developing drug toxicity if the dose is unadjusted. Diabetic ketoacidosis is a rare adverse drug effect reported with the use of tacrolimus. In this report, we present a case of DKA in a 60-year-old woman with polymyositis on low dose corticosteroids and tacrolimus, precipitated by the use of fluconazole. We highlight the pathophysiologic mechanisms underlying the effect of fluconazole on tacrolimus levels causing an accelerated development of DKA along with the review of literature on this potentially life-threatening condition.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tacrolimus-induced Diabetic Ketoacidosis in a Polymyositis Patient Precipitated by Fluconazole: A Case Report and Review of the Literature

Chaudhary¹,

Kumar²,

Chigurupati³

et al. 2020

AJMCR

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“…[10] Although it is unclear why only a few TAC-receiving individuals develop DKA, 15 cases of TAC-induced DKA have been reported after transplantation. [1] Mean age of these patients was 29.9 years; 47% of them were men; average BMI was in the normal range (22.1 ± 4.7 kg/m 2 ) and 40% developed DKA within the first 3 months of transplantation. Table 2 shows details of the TAC-induced DKA cases that involved diseases other than transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…[1] The diabetogenic potential of TAC is considered to involve suppression of insulin secretion from pancreatic beta cells by inhibiting transcription of the insulin gene, due to the association between TAC and the FK506-binding protein 12 (FKBP-12). [2] Although some cases of TAC-related diabetic ketoacidosis (DKA) have been reported, [1,3] few cases have involved changes in insulin secretion before and after TAC cessation. Herein, we reported a case of DKA induced by TAC, which was being administered for interstitial pneumonia treatment, with subsequent rapid recovery of endogenous insulin secretion after cessation of TAC administration.…”

Section: Introductionmentioning

confidence: 99%

Tacrolimus-induced diabetic ketoacidosis with subsequent rapid recovery of endogenous insulin secretion after cessation of tacrolimus

Maruyama

Chujo

2019

Medicine

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Rationale:Immunosuppressive agents such as tacrolimus (TAC) and cyclosporin might cause glycemic disorders by suppressing insulin production. However, only a few cases of diabetic ketoacidosis (DKA) with longitudinal evaluation of endogenous insulin secretion related to TAC administration have been reported.Patient concerns:A 59-year-old Asian woman, who received prednisolone and TAC 4.0 mg for the treatment of anti-aminoacyl-tRNA synthetase antibody-positive interstitial pneumonia, was admitted to our hospital due to impaired consciousness and general malaise.Diagnoses:She had metabolic acidosis; her plasma glucose, fasting serum C-peptide immunoreactivity (CPR), and urinary CPR levels were 989 mg/dL (54.9 mmol/L), 0.62 ng/mL, and 13.4 μg/d, respectively. No islet-related autoantibodies were detected. Therefore, she was diagnosed with TAC-induced DKA.Intervention:Intravenous continuous insulin infusion and rapid saline infusion were administered. TAC was discontinued because of its diabetogenic potential.Outcomes:Sixteen weeks after cessation of TAC administration, she showed good glycemic control without administration of insulin or any oral hypoglycemic agents; her serum CPR level also improved dramatically. These findings suggested that TAC-induced pancreatic beta cell toxicity is reversible.Lessons:We reported a case of TAC-induced DKA with subsequent recovery of pancreatic beta cell function after cessation of TAC, resulting in good glycemic control. As TAC is widely used, we should pay attention to patients’ glucose levels even though the TAC concentrations used are within the target range. Furthermore, dose reduction or cessation of TAC should be considered if hyperglycemia is detected during administration of this agent.

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“…5 The mechanism of action by which tacrolimus leads to hyperglycemia is believed to be by reversible toxicity to the beta islet cells and thus affecting regulation of insulin. 5…”

mentioning

confidence: 99%

Tacrolimus-Induced Hyperosmolar Hyperglycemic Syndrome and the Role of Phenytoin in Tacrolimus Toxicity

Kabashneh

Wadehra

2020

American Journal of Therapeutics

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Posttransplant Tacrolimus-Induced Diabetic Ketoacidosis: Review of the Literature

Cited by 5 publications

References 25 publications

Tacrolimus-induced Diabetic Ketoacidosis in a Polymyositis Patient Precipitated by Fluconazole: A Case Report and Review of the Literature

Tacrolimus-induced Diabetic Ketoacidosis in a Polymyositis Patient Precipitated by Fluconazole: A Case Report and Review of the Literature

Tacrolimus-induced diabetic ketoacidosis with subsequent rapid recovery of endogenous insulin secretion after cessation of tacrolimus

Tacrolimus-Induced Hyperosmolar Hyperglycemic Syndrome and the Role of Phenytoin in Tacrolimus Toxicity

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