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

Dusten T Rose; Saurin M Gandhi; Rachael A Bedard; Kristin E Mondy; Alexander L Chu; Kelly C Gamble; Amanda T Gee; Monica A Kundra; Amber L Williams; Brian K Lee

doi:10.1093/ofid/ofac238

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

Open Forum Infect Dis. 2022 May 13;9(7):ofac238. doi: 10.1093/ofid/ofac238. eCollection 2022 Jul.

Authors

Affiliations

¹ Department of Pharmacy, Ascension Seton, Dell Seton Medical at The University of Texas, Austin, Texas, USA.
² Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas, USA.
³ Division of Infectious Diseases, Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas, USA.
⁴ Department of Medical Education, Dell Medical School, University of Texas at Austin, Austin, Texas, USA.
⁵ Kidney and Pancreas Transplant Program, Dell Seton Medical Center, University of Texas at Austin, Austin, Texas, USA.

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.

Publication types

Case Reports