{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T17:22:38Z","timestamp":1755796958534,"version":"3.44.0"},"reference-count":10,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T00:00:00Z","timestamp":1655424000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Clotrimazole troches are used as prophylaxis against oropharyngeal candidiasis post\u2010transplant and have limited systemic absorption. Following several occurrences of tacrolimus concentration fluctuations after clotrimazole discontinuation, its use as prophylaxis was discontinued post\u2010kidney transplant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study to evaluate the effect of clotrimazole prophylaxis on tacrolimus trough concentrations post\u2010kidney transplant. The study included adult patients who received a kidney transplant at Cleveland Clinic Main Campus from August 1, 2019 to July 1, 2020 and were maintained on per\u2010protocol, standard\u2010dose tacrolimus through 90\u00a0days post\u2010transplant. Patients were excluded if they received cyclosporine, systemic antifungals, strong CYP3A4 inhibitors or inducers, or a simultaneous multiorgan transplant. The primary objective was to compare tacrolimus trough concentrations before and after completion of clotrimazole prophylaxis. Secondary objectives were to compare the time to first post\u2010transplant goal tacrolimus trough concentration, the rate of for\u2010cause allograft biopsies within 90\u00a0days after transplant, and the incidence and type of candidiasis within 30 days after transplant, pre\u2010 and post\u2010protocol change.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Following clotrimazole discontinuation, the median tacrolimus trough concentration decreased from 10.5\u00a0ng\/ml (IQR 8.4\u201312.2) to 6.6\u00a0ng\/ml (IQR 5\u20138.7, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001). No statistically significant differences in the rate of for\u2010cause allograft biopsies (4.9%\u00a0vs. 9.7%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.264) or incidence of candidiasis (1.2%\u00a0vs. 5.4%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.217) were observed between those who received clotrimazole and those who did not receive clotrimazole.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our study provides further evidence of a significant drug\u2013drug interaction between tacrolimus and clotrimazole among kidney transplant recipients that can potentially lead to negative allograft outcomes.\n<jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/tid13882-gra-0001-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text><\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.13882","type":"journal-article","created":{"date-parts":[[2022,6,11]],"date-time":"2022-06-11T05:59:52Z","timestamp":1654927192000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of clotrimazole prophylaxis on tacrolimus trough concentrations in kidney transplant recipients"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0287-5973","authenticated-orcid":false,"given":"Emily","family":"Wings","sequence":"first","affiliation":[{"name":"Department of Pharmacy Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5340-2802","authenticated-orcid":false,"given":"Michael","family":"Spinner","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5208-2832","authenticated-orcid":false,"given":"Jamie","family":"Eckardt","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,6,17]]},"reference":[{"issue":"3","key":"e_1_2_8_2_1","first-page":"S1","article-title":"Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients","volume":"9","author":"Kidney Disease","year":"2009","journal-title":"Am J Transplant"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13623"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1984.00350140096014"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1185\/03007997709110160"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-0012.2001.150203.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1718"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-018-2558-6"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2009.03559.x"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12035"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/tid.13559"}],"container-title":["Transplant Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.13882","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/tid.13882","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.13882","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T11:02:59Z","timestamp":1755514979000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tid.13882"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,17]]},"references-count":10,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,8]]}},"alternative-id":["10.1111\/tid.13882"],"URL":"https:\/\/doi.org\/10.1111\/tid.13882","archive":["Portico"],"relation":{},"ISSN":["1398-2273","1399-3062"],"issn-type":[{"type":"print","value":"1398-2273"},{"type":"electronic","value":"1399-3062"}],"subject":[],"published":{"date-parts":[[2022,6,17]]},"assertion":[{"value":"2022-02-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13882"}}