Pharmaceutical Consideration on Combined Use of Rifampicin and Immunosuppressive Drugs: A Case Report of a Patient who Developed Pulmonary Tuberculosis Four Months after Kidney Transplantation

• Published in: Japanese Journal of National Medical Services Vol. 60; no. 10; pp. 652 - 657
• Main Authors: YAMAMOTO, Yoshiaki, SUGANUMA, Ayako, TAKI, Hisashi, FUNAKI, Hiromu, HORIBE, Chiharu, TARUMI, Osamu, OGAWA, Kenji
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of National Medical Services 2006
• Subjects: drug interaction; mycophenolate mofetil (MMF); rifampicin; tacrolimus; tuberculosis
• ISSN: 0021-1699; 1884-8729
• DOI: 10.11261/iryo1946.60.652

Patients who have received organ donation are exposed to a high risk of the onset of tuberculosis. We experienced a case where pulmonary tuberculosis developed after kidney transplantation. The trough level of tacrolimus (FK) for the patient, who had received administration of mycophenolate mofetil, FK, prednisolone decreased to 3.2ng/ml 14 days after administration of rifampicin began, though it was 8.5ng/ml on the first day. Even though the dosage of FK was doubled, the blood level of FK decreased more. Finally, 3.5ng/ml blood level was obtained when dosage had been enhanced to four times. Without rejection, the examination of sputum test of the patient became negative35days after taking antituberculosis drugs. RFP could affect metabolism of various immunosuppressive drugs when used for transplant patients, and regulation of dosage is required. In this case it was possible for the patient to continue to take immunosuppressive drugs while taking antituberculosis drugs, and we could get a good course. The therapy to cure tuberculosis while controlling the rejection is not clear for the patients who have received organ transplants and developed tuberculosis. It was concluded that it is important to establish a database to deal with future cases and give feedback of the information to the clinical site.