Impact of Antimalarial Therapy on Calcineurin Inhibitor Levels in a Solid Organ Transplant Recipient

 

Calcineurin inhibitors include cyclosporine and tacrolimus.

 

Antimalarial drugs that can increase serum levels of a calcineurin inhibitor:

(1) mefloquine (Lariam)

(2) doxycycline

(3) chloroquine (Aralen)

(4) primaquine

 

An increase in the serum level of a calcineurin inhibitor increases the risk of a toxic effect.

 

Antimalarial drugs that can decrease serum levels of a calcineurin inhibitor:

(1) sulfadoxine/pyrimethamine (Fansidar)

 

A decrease in the serum level of a calcineurin inhibitor may increase the risk of organ rejection.

 

Recommendations:

(1) The patient needs to be stabilized on the various medications prior to departure.

(2) The patient needs to be adherent to the drug regimen that has been established while at risk for malaria.

(3) The drugs need to be readjusted once the antimalarials are discontinued.