Tacrolimus Related Brady and Tachyarrhythmias in a Familial Amyloid Polyneuropathy Patient who Underwent Partial Liver Transplantation

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概要

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• Liver transplantation has become a valuable treatment for FAP and tacrolimus is highly effective for the prevention of liver allograft rejection. Recently, tacrolimus-induced sinus bradycardia and QT prolongation with ventricular tachycardia have been reported, though no relationship to the plasma concentration of tacrolimus was suggested. On the 80th day after both liver transplantation and the start of tacrolimus administration, our patient experienced syncope. An ECG taken immediately revealed an additional right bundle branch block and the QT interval prolongation (corrected QT interval was 509 msec, which had slightly increased compared to 4 days before). The next day she suffered another attack and ECG monitoring disclosed wide QRS tachycardia (240beats/minute). On the 82nd day wide ORS tachycardia (206beats/minute) reappeared. During the following one week she suffered two episodes of dizziness and ECG showed marked bradycardia (35beats/minute). Sinus bradycardia or sinoatrial block was suspected. In our patient the occurrence of transient RBBB, marked bradycardia (possibly sinoatrial block) and wide QRS tachycardia were considered to possibly be due to conduction block caused by the use of tacrolimus. Because brady-and tachyarrhythmias have been newly developed after liver transplantation under the tacrolimus regimen, and the tachyarrhythmias have diminished after chang-ing the tacrolimus administration to cyclosporin, we speculate that brady-and tachy-arrhythmias were thus possibly caused by tacrolimus. In addition, the amyloid heart in FAP might be more sensitive to the intracellular calcium accumulation effect of tacrolimus, because the administration of tacrolimus does not result in an overdose based on the doses and trough levels of tacrolimus.

• 日本医療薬学会の論文
• 2001-10-10

著者

• IKEDA Shu-ichi

  Third Department of Medicine, Shinshu University School of Medicine

• KAWASAKI Seiji

  First Department of Surgery, Shinsyu University School of Medicine

• Sato Shunichi

  Third Department of Internal Medicine, Saitama Medical Center

• KATSUYAMA Yoshihiko

  Department of Pharmacy, Shinshu University Hospital

• Kawasaki Seiji

  日本赤十字社医療センター

• Kawasaki Seiji

  First Department Of Surgery Shinshu University School Of Medicine

• TAKEI Yo-ichi

  Third Department of Medicine, Shinshu University School of Medicine

• OHTA SHIN

  Department of Pharmacy, Shinshu University Hospital

• OWA Mafumi

  the Third Department of Internal Medicine

• Owa Mafumi

  Third Department of Internal Medicine

• Sakurai Shunpei

  Third Department of Internal Medicine

• Katsuyama Yoshihiko

  Department Of Hospital Pharmacy Shinshu University School Of Medicine

• Sato Shunichi

  Third Department Of Internal Medicine Shinshu University School Of Medicine

• Ohta Shin

  Department Of Hospital Pharmacy Shinshu University School Of Medicine

• Takei Yo-ichi

  Third Department Of Medicine Shinshu University School Of Medicine

• Ikeda Shu-ichi

  Third Department Of Medicine Shinshu University School Of Medicine

• Sakurai Shunpei

  Third Department Of Internal Medicine Shinshu University School Of Medicine

• Owa Mafumi

  Third Department Of Medicine Shinshu University School Of Medicine

• Ikeda Shu-ihci

  Dep. Of Medicine (neurology And Rheumatology) Shinshu Univ. School Of Medicine

• Ikeda Shu-ichi

  Third Department Of Medicine (neurology And Rheumatology) Shinshu University School Of Medicine

• Katsuyama Yoshihiko

  Department of Hospital Pharmacy

• Ohta Shin

  Department of Functional Molecular Chemistry, Kyoto Pharmaceutical University

• Sato Shunichi

  Third Department of Internal Medicine

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