Author(s) : H Michelon, H Sterlingot, N Arzouk, AM Taburet, A Durrbach, V Furlan , Service de pharmacie-toxicologie, CHU de Bicêtre, le Kremlin-Bicêtre, Service de néphrologie, CHU de Bicêtre, le Kremlin-Bicêtre.
Summary : Fumagillin, antibiotic derived from A. fumigatus, is a new treatment for chronic E. bieneusi infection in immunocompromised patients. The pharmacokinetic properties and drug-drug interaction with substrate of cytochrome P450 3A4 and/or P-glycoprotein (Pgp) are presently unknown. We report the case of a renal transplant recipient who was in a stable regimen tacrolimus and developed diarrhoeas due to microsporidiosis treated by fumagillin. A decrease in tacrolimus whole blood concentration by 50% was observed after starting fumagillin. Tacrolimus pharmacokinetic study before and after initiation of fumagillin showed a decrease in tacrolimus ASC by 32% and an increase Cl/F by 46%. An induction of tacrolimus metabolic enzymes or transporters by fumagillin is the likely mechanism of this interaction. A close monitoring of tacrolimus concentrations and frequent dose adjustments may be required whether fumagillin is administered in patients who receive tacrolimus.
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