A 34-year old man with ESRD nine years post-renal transplant presented with mild SARS-CoV-2 symptoms. Due to the patient’s unvaccinated SARS-CoV-2 status and high risk for progression to severe disease, nirmatrelvir and ritonavir twice daily was started at a renally adjusted dose (baseline sCr 1.2-1.5 mg/dL).
Current medications: amlodipine, calcitriol, cholecalciferol, leflunomide, lisinopril, magnesium oxide, omeprazole, prednisone, tacrolimus
The patient took the morning nirmatrelvir and ritonavir dose on day 3 of treatment then wanted to stop due to N/V. Labs drawn on day 2 but not available until day 3 showed sCr 1.42 mg/dL and tacrolimus level >30 ng/dL (goal range 4-6 ng/dL). Medications were immediately adjusted and the patient’s symptoms began to improve on day 4. However, his sCr continued to climb to 1.62 mg/dL on day 7, and then peaked at 1.79 mg/dL on day 10. Tacrolimus levels were >30 ng/dL on day 7 and 8.8 ng/dL on day 10.
Which drug combo could have caused the patient’s acute renal injury?
Current medications: amlodipine, calcitriol, cholecalciferol, leflunomide, lisinopril, magnesium oxide, omeprazole, prednisone, tacrolimus
The patient took the morning nirmatrelvir and ritonavir dose on day 3 of treatment then wanted to stop due to N/V. Labs drawn on day 2 but not available until day 3 showed sCr 1.42 mg/dL and tacrolimus level >30 ng/dL (goal range 4-6 ng/dL). Medications were immediately adjusted and the patient’s symptoms began to improve on day 4. However, his sCr continued to climb to 1.62 mg/dL on day 7, and then peaked at 1.79 mg/dL on day 10. Tacrolimus levels were >30 ng/dL on day 7 and 8.8 ng/dL on day 10.
Which drug combo could have caused the patient’s acute renal injury?
|
amlodipine and nirmatrelvir and ritonavir
|
|
omeprazole and nirmatrelvir and ritonavir
|
|
leflunomide and nirmatrelvir and ritonavir
|
|
tacrolimus and nirmatrelvir and ritonavir
|