TACROLIMUS (FK506) MALABSORPTION - MANAGEMENT WITH FLUCONAZOLE COADMINISTRATION

We report the use of fluconazole to control primary immunosuppressive management with tacrolimus in a 9-year-old liver transplant recipient. Progressive increases in the doses of both cyclosporin (up to 20 mg/k g/day) and, subsequently, tacrolimus (up to 60 mg/day) failed to maint ain immunosuppressive levels of both agents. After excluding poor comp liance, drug interactions and analytical problems and identifying poor bioavailability (< 2.6 %) and rapid clearance (4.2 l/h), fluconazole (100 mg/day) was initiated to inhibit tacrolimus metabolism and consis tent therapeutic blood levels of tacrolimus were achieved. How ever, g raft function had deteriorated irrevocably and retransplantation was p erformed. Simultaneous use of tacrolimus (5 mg/day) and fluconazole (1 00 mg/day) maintained immunosuppression after transplantation. Three w eeks later, obstruction of the Roux loop caused deteriorating liver fu nction and tacrolimus blood levels fell. After correction at laparotom y, stabilisation was achieved and discharge was possible on 5 mg tacro limus b.i.d. plus fluconazole (100 mg).