{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T13:09:31Z","timestamp":1758632971632,"version":"3.41.2"},"reference-count":15,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,9,3]],"date-time":"2018-09-03T00:00:00Z","timestamp":1535932800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Tacrolimus is a cornerstone of immunosuppression after transplantation but is highly susceptible to changes from interacting variables and has a narrow therapeutic index. Clotrimazole troches are commonly used as a non\u2010systemic antifungal to prevent oral candidiasis. Studies suggest that clotrimazole troches, though minimally absorbed systemically, may affect tacrolimus concentrations by inhibition of metabolic enzyme activity in the intestines. However, the magnitude of the impact of clotrimazole on tacrolimus dosing requirements to maintain goal levels is not well described.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>To assess this, tacrolimus dose adjustments and trough concentrations were retrospectively examined in 95 heart transplant recipients before and after the discontinuation of clotrimazole.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median percent tacrolimus dose change was an increase of 66.7% (<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content>28.6%, 100%) after clotrimazole discontinuation, and the median trough concentration percent change from baseline to the first trough after clotrimazole discontinuation (in the absence of a dose change) was \u221242.5% (<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content>\u221252.3%, \u221230.9%). Five cases of allograft rejection were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In conclusion, clotrimazole troches exert a meaningful interaction with tacrolimus that requires close monitoring and dose adjustment. The data from this single\u2010center study provide novel information that could guide providers on the degree of tacrolimus dose adjustment needed when discontinuing clotrimazole prophylaxis after heart transplantation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.12979","type":"journal-article","created":{"date-parts":[[2018,8,18]],"date-time":"2018-08-18T11:39:03Z","timestamp":1534592343000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Effects of clotrimazole troches on tacrolimus dosing in heart transplant recipients"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6251-9153","authenticated-orcid":false,"given":"Melissa R.","family":"Laub","sequence":"first","affiliation":[{"name":"Division of Pharmacy Services Mayo Clinic Hospital Rochester Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stacy A.","family":"Crow","sequence":"additional","affiliation":[{"name":"Division of Pharmacy Services Mayo Clinic Hospital Rochester Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather A.","family":"Personett","sequence":"additional","affiliation":[{"name":"Division of Pharmacy Services Mayo Clinic Hospital Rochester Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ross","family":"Dierkhising","sequence":"additional","affiliation":[{"name":"Division of Biomedical Statistics and Informatics Mayo Clinic Hospital Rochester Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barry","family":"Boilson","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases Mayo Clinic Hospital Rochester Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymund","family":"Razonable","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Mayo Clinic Hospital Rochester Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,9,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.coph.2015.07.002"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200241110-00003"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-199529060-00003"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1592\/phco.26.12.1730"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200140030-00002"},{"issue":"12","key":"e_1_2_8_7_1","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1016\/S0090-9556(25)06862-X","article-title":"Metabolism of the immunosuppressant tacrolimus in the small intestine: cytochrome P450, drug interactions, and interindividual variability","volume":"23","author":"Lampen A","year":"1995","journal-title":"Drug Metab 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