Safety of Coadministaraion of Teicoplanin and Tacrolimus After Allogeneic Hematopoietic Stem Cell Transplantation

[BACKGROUND]

Tacrolimus has been widely used for the prophylaxis or treatment of graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT). Among its side effects, nephrotoxicity is often clinically problematic. Recipients of HSCT are highly susceptible to the infection due to drug-resistant gram positive bacteria, and thus nephrotoxic glycopeptide antimicrobial agents such as teicoplanin and vancomycin are often administered. Since the nephrotoxicity of coadministration of teicoplanin and tacrolimus has yet to be evaluated, it was retrospectively evaluated in the setting of allogeneic HSCT.

[PATIENTS & METHODS]

Recipients of allogeneic HSCT for hematological diseases who received intravenous teicoplanin for more than 4 days during the continuous intravenous infusion of tacrolimus within 30 days after transplantation were selected from the data base. Patients who received liposomal amphotericin-B or foscarnet were excluded. The data including patient demographics, whole blood concentration of tacrolimus, dose and duration of teicoplanin administration, and serum creatinine (sCr) were collected. Therapeutic drug monitoring of tacrolimus and teicoplanin was performed in all the patients.

[RESULTS]

Sixty-seven patients fulfilled criteria, and were included in the analysis. Median age of the patients was 48 years (range: 16-62), and median duration of the coadministration of teicoplanin and tacrolimus was 11 days (range: 4-40). Mean whole blood concentration of tacrolimus during teicoplanin administration were 16.3+1.7 ng/ml. Twice or greater increases of sCr compared with that before initiating teicoplanin were observed only in 2 (3.0%) of 67 patients. Nephrotoxicity was reversible and manageable in all cases by discontinuation of teicoplanin with or without dose adjustment of tacrolimus.

[CONCLUSION]

Teicoplanin can safely be coadministered with tacrolimus even in the early post-transplant period under the appropriate management with therapeutic drug monitoring of each drug.