{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T02:00:45Z","timestamp":1793325645952,"version":"4.5.0"},"reference-count":18,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,6,24]]},"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:p>A 40-year-old woman with a history of chronic graft-versus-host-disease on immunosuppression with tacrolimus presented to the hospital with somnolence, confusion and muscle cramps over a few days. She was found to have hypertension, hyperglycaemia and acute kidney injury with an elevated blood tacrolimus level of greater than 120\u2009ng\/mL (reference range 5\u201315\u2009ng\/mL). Discontinuation of tacrolimus with concomitant administration of intravenous phenytoin led to the successful reduction of elevated tacrolimus concentrations and the resolution of her symptoms. Tacrolimus is metabolised by the cytochrome P (CYP) 450 3A enzyme system, and utilisation of CYP 3A inducers to accelerate its clearance may be used as a successful therapy to treat tacrolimus toxicity.<\/jats:p>","DOI":"10.1136\/bcr-2020-234839","type":"journal-article","created":{"date-parts":[[2020,7,21]],"date-time":"2020-07-21T02:02:48Z","timestamp":1595296968000},"page":"e234839","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Use of phenytoin for treatment of tacrolimus toxicity with superimposed sepsis"],"prefix":"10.1136","volume":"13","author":[{"given":"Aditi","family":"Sharma","sequence":"first","affiliation":[{"name":"Internal Medicine, Wayne State University, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista A","family":"Wahby","sequence":"additional","affiliation":[{"name":"Pharmacy, Detroit Medical Center, Detroit, Michigan, 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