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The effect of deoxyschisandrin on blood tacrolimus levels: a case report

Background and aim: It is well known that tacrolimus (FK-506 or Prograf [Tac]) is widely used to prevent allograft rejection after liver transplantation. Herein, we report a case of a living-donor liver transplant recipient who displayed increased Tac level during concomitant usage of deoxyschisandrin. Materials and methods: The recipient is a 42-year-old male who received a liver transplant from his sister for hepatitis B-related hepatocirrhosis. Immunosuppression was initiated with Tac, corticosteroids, and mycophenolate mofetil. Fifteen months after transplantation, he received Tac at an oral dose of 6 mg per day alone to avoid allograft rejection. Then he experienced over low Tac concentration, diarrhea and an increase in serum alanine aminotransferase (ALT) during this phase. Thus, he was readmitted to the hospital two days later. Because of unstable liver function, deoxyschisandrin therapy was initiated at a dose of 22.5 mg after each meal. Results: Three days later, the blood Tac concentration increased from 2.3 ng/mL to 17.7 ng/mL. Conclusions: Deoxyschisandrin could markedly increase the blood level of Tac in this liver transplant patient. Monitoring the trough levels of Tac frequently is recommended when deoxyschisandrin is co-administered.