Pharmacokinetic interaction between tacrolimus and berberine in a child with idiopathic nephrotic syndrome

摘要

Berberine is a major isoquinoline alkaloid in herbs such as goldenseal, berberis, and Coptis chinensis and has been traditionally used to treat diarrhea [1]. We report here a well-documented interaction between tacrolimus and berberine in a child with idiopathic nephrotic syndrome. A 16-year-old child was confirmed to have nephrotic syndrome after observation of 1-month history of generalized edema associated with persistent proteinuria in April 2012. The immunosuppressive therapy was initialed with prednisone (60 mg/m~2/day), frequent relapses occurs when prednisone dose was reduced to 40 mg/m~2/day. Tacrolimus (0.1 mg/kg, twice daily) was then added to immunosuppressive therapy. Tacrolimus dosage adjustment was based on therapeutic drug monitoring (TDM) in order to maintain trough blood concentration (Co) in the therapeutic range of 5-15 ng/mL [2].