Severe reduction in tacrolimus concentrations with concomitant metamizole (dipyrone) therapy in transplant patients
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To the Editors:
Tacrolimus is a substrate of cytochrome (CYP) 3A4/3A5 and P-glycoprotein (Pgp) and its use therefore entails the risk for drug–drug interactions. The analgesic drug metamizole (dipyrone) has shown in vitro potential as an inducer of CYP2B6 and CYP3A4 . Furthermore, in an in vivo study a short-term administration of metamizole decreased the blood concentrations of cyclosporine (which is also a substrate of CYP3A4/3A5) with a latency of few hours . However, cyclosporine, in contrast to tacrolimus, is more intensively metabolized by CYP3A4 than by CYP3A5 . In the Swiss medicinal product information of tacrolimus supplied by the Swiss federal drug authority (Swissmedic) it is stated that metamizole is able to decrease tacrolimus’ drug concentrations . Yet, no case reports of co-administration of metamizole and tacrolimus have been published.
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Conflicts of interest
All authors declare that there are no conflicts of interest.
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