Hydroxychloroquine + Tacrolimus = Precautionary

Effect on Concentration

Hydroxychloroquine
Unknown
Applies within class?
No
Tacrolimus
Increase
Applies within class?
No

Pharmacologic Effects

Hydroxychloroquine
Effect
N/A
Applies within class?
No
Tacrolimus
Effect
N/A
Applies within class?
No

Interaction History

N/A

Last Updated 19-May-2020

Summary

Likely potent CyP enzyme inhibitors (ritonavir, cobicistat) mostly contributed to high tacrolimus levels. HQ was in the mix.

Sources

Threatening drug-drug interaction in a kidney transplant patient with Coronavirus Disease 2019 (COVID-19) ^

Study Design

Case of a 36-year-old kidney transplanted woman affected by Senior-Loken syndrome diagnosed with COVID-19 pneumonia after a contact with her positive mother. Initial symptoms were fatigue, dry cough and coryza; she never had fever nor oxygen supplementation. Hydroxychloroquine and lopinavir/ritonavir were started, and the antiviral drug was replaced with darunavir/cobicistat after two days for diarrhea.

Study Results

Immunosuppressant levels were closely monitored, and very high tacrolimus trough levels were observed despite initial dose reduction.

Study Conclusions

References

Bartiromo M. Threatening drug-drug interaction in a kidney transplant patient with coronavirus disease 2019 (covid-19). Transpl Infect Dis. 2020; : .