Significant tacrolimus and dronedarone interaction in a kidney transplant recipient.

Kidney Transplant Recipient Dronedarone is a recently available derivate of amiodarone indicated for the treatment of atrial fibrillation (1). Dronedarone seems to have improved tolerability, taking out the noncardiovascular adverse effects of amiodarone (2) and lack of interaction with oral anticoagulants (3). Dronedarone may have the ability to increase the concentration of CYP3A4 substrates, such as tacrolimus. Besides, dronedarone is an inhibitor of the P-glycoprotein efflux pump in the gastrointestinal tract, enhancing absorption of some drugs. Theoretically, dronedarone may increase tacrolimus levels, promoting tacrolimus toxicity and potentially extending QT interval in the electrocardiogram (4, 5). There are no reports that identify and describe management of the interaction between tacrolimus and dronedarone and its impact in clinical practice.

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