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Case report
Use of phenytoin for treatment of tacrolimus toxicity with superimposed sepsis
  1. Aditi Sharma1,
  2. Krista A Wahby2,
  3. Mohammed Inany3 and
  4. Sarah J Lee3
  1. 1Internal Medicine, Wayne State University, Detroit, Michigan, USA
  2. 2Pharmacy, Detroit Medical Center, Detroit, Michigan, USA
  3. 3Pulmonary Critical Care, Wayne State University, Detroit, Michigan, USA
  1. Correspondence to Dr Aditi Sharma; gr6745{at}


A 40-year-old woman with a history of chronic graft-versus-host-disease on immunosuppression with tacrolimus presented to the hospital with somnolence, confusion and muscle cramps over a few days. She was found to have hypertension, hyperglycaemia and acute kidney injury with an elevated blood tacrolimus level of greater than 120 ng/mL (reference range 5–15 ng/mL). Discontinuation of tacrolimus with concomitant administration of intravenous phenytoin led to the successful reduction of elevated tacrolimus concentrations and the resolution of her symptoms. Tacrolimus is metabolised by the cytochrome P (CYP) 450 3A enzyme system, and utilisation of CYP 3A inducers to accelerate its clearance may be used as a successful therapy to treat tacrolimus toxicity.

  • malignant disease and immunosuppression
  • adult intensive care
  • toxicology
  • acute renal failure

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  • Contributors AS, KAW, MI and SJL made substantial contributions to the conception or design of the work, the acquisition, analysis and interpretation of data. AS, KAW, MI and SJL drafted the work and revised it critically for important intellectual content. AS, KAW, MI and SJL contributed to and approved the final version of the manuscript. AS, KAW, MI and SJL are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.