Potential Effects of Remdesivir on Tacrolimus Exposure in Transplant Recipients With COVID-19 Infection

Habeeb, Ehsan; Gabardi, Steven; Townsend, Keri; Kim, Min Ji

doi:10.1016/j.ekir.2023.04.028

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…Some authors reported a significant increase in the serum concentration of tacrolimus when using RDV. The correct management of tacrolimus levels is critical both for the prevention of graft rejection and for the avoidance of excessive immunosuppression and drug toxicities [ 19 , 42 , 43 ]. Habeeb E et al showed that levels significantly increased, peaking on day 3 of RDV therapy and returning to normal levels 10 days after the discontinuation of RDV.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and Safety of Remdesivir in Adult Solid Organ Transplant Recipients: A Scoping Review

Smith,

Novara,

Cona

et al. 2024

Pharmaceuticals

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The SARS-CoV-2 infection has been associated with important mortality, particularly in immunocompromised patients, including solid organ transplant (SOT) recipients. Remdesivir (RDV) is an antiviral drug that has proven to be effective in reducing the replication of the virus in host cells, by which it may reduce the progression of symptoms and, consequently, the length of hospital stay and mortality. Randomized controlled trials have evaluated its use in the general population but never in SOT recipients. For the first time in this review, the safety and efficacy of RDV is evaluated in this specific population. The literature research was conducted using PubMed/MEDLINE and Scopus databases from 1 January 2020 to 24 November 2023, and 23 studies were analyzed. Although no clinical studies specifically evaluating this population have been conducted yet, RDV is likely safe for SOT patients when compared to the general population, so prescribers should consider utilizing RDV in SOT patients who are at high risk for progression to severe COVID-19. Future research will allow for the confirmation of the observed results and the acquisition of broader and clearer data regarding the safety and efficacy of the drug in this specific setting.

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Section: Resultsmentioning

confidence: 99%

“…This potential adverse event should be considered when utilizing RDV in any patient receiving tacrolimus and, through level, should be closely monitored. However, compared to other antivirals, including nirmatrelvir/ritonavir, RDV has fewer drug interactions with immunosuppressants [ 19 ].…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Remdesivir in Adult Solid Organ Transplant Recipients: A Scoping Review

Smith,

Novara,

Cona

et al. 2024

Pharmaceuticals

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“…Medications co-administered with NMV/r, such as amlodipine and prednisolone, reportedly increase blood TAC levels, however, none of these medications had stronger interactions than NMV/r [ 16 - 18 ]. In addition, blood TAC levels reportedly increased upon remdesivir administration, which is used to treat patients with COVID-19 after NMV/r discontinuation [ 19 ]. However, remdesivir limitedly affects blood TAC levels because it is rapidly excreted [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Abnormally Elevated Blood Tacrolimus Level Following the Concomitant Use of Nirmatrelvir/Ritonavir With Extended-Release Tacrolimus in a Post-lung Transplant Patient: A Case Report and a Literature Review

Yoshida,

Umemura,

Ito

et al. 2024

Cureus

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Although nirmatrelvir/ritonavir (NMV/r) reportedly increases blood levels of tacrolimus (TAC) due to CYP3A4 inhibition and other factors, reports on the use of NMV/r in combination with tacrolimus hydrate extended-release capsules (TAC-ER) in lung transplant patients are limited. Herein, we present a case with post-lung transplantation of elevated blood trough levels of TAC after concomitant use of NMV/r. A woman in her 60s had undergone lung transplantation. She had coronavirus disease 2019 (COVID-19) and was co-administered NMV/r and TAC-ER, with the trough level controlled at approximately 4 μg/mL. Upon the co-administration of NMV/r and TAC-ER, the patient developed diarrhea and vomiting and was hospitalized. TAC-ER was discontinued on day 6, and TAC level was measured on day 8 and had risen above 100 ng/mL. This level gradually decreased to 17.8 ng/mL on day 11 and 2.4 ng/mL on day 15; therefore, TAC-ER was resumed at 2.5 mg/day. On day 18, the TAC level was 5.2 ng/mL, which was within the target range, and the patient was discharged on day 19. This is the first report of a post-lung transplant patient co-administered TAC-ER with NMV/r, who showed abnormally high blood TAC levels above the detection limit. In patients using TAC-ER after lung transplantation, it may be useful to confirm that the TAC blood level is below the effective therapeutic range before resuming TAC-ER safely.

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Remdesivir: treatment of COVID-19 in special populations

Molaei,

Hayes

et al. 2024

Naunyn-Schmiedeberg's Arch Pharmacol

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Potential Effects of Remdesivir on Tacrolimus Exposure in Transplant Recipients With COVID-19 Infection

Cited by 4 publications

References 15 publications

Efficacy and Safety of Remdesivir in Adult Solid Organ Transplant Recipients: A Scoping Review

Efficacy and Safety of Remdesivir in Adult Solid Organ Transplant Recipients: A Scoping Review

Abnormally Elevated Blood Tacrolimus Level Following the Concomitant Use of Nirmatrelvir/Ritonavir With Extended-Release Tacrolimus in a Post-lung Transplant Patient: A Case Report and a Literature Review

Remdesivir: treatment of COVID-19 in special populations

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