ZHU Yuan-chao, ZHAO Ming, LIANG Liang, YANG Li-ping*, HU Xin
Department of Pharmacy, Beijing Hospital, Ministry of Public Health, Assessment of Clinical Drugs Risk and Individual Application Key Laboratory; National Clinical Center of Respiratory Diseases, Beijing 100730, China
Abstract：A patient with myasthenia gravis was treated with tacrolimus, and his tacrolimus blood level was stable at 5-7 ng?mL-1 previously. To eradicate Helicobacter pylori, quadruple therapy was added after hospitalization, which consisted of amoxicillin, clarithromycin,bismuth and esomeprazole. Blood level of tacrolimus soon rose to 64.71 ng?mL-1, while the patient experienced myasthenia gravis symptoms free and adverse reactions. Tacrolimus and quadruple therapy were discontinued. 7 days later, blood level declined to 5.06 ng?mL-1.
[1] 中华医学会神经病学会神经免疫学组，中国免疫学会神经免疫学分会．中国重症肌无力诊断和治疗专家共识[J]．中国神经免疫学和神经病学杂志，2012，19(6)：401-408．
[2] Mitsui T, Kunishig M, Ichimiya M, et al. Beneficial effect of tacrolimus on myasthenia gravis with thymoma[J]. Neurologist,2007, 13(2):83-86.
[3] Niioka T, Kagaya H, Saito M, et al. Capability of utilizing CYP3A5 polymorphisms to predict therapeutic dosage of tacrolimus at early stage post-renal transplantation[J]. Int J Mol Sci, 2015, 16(1):1840-1854.
[4] Ambudkar S V, Dey S, Hrycyna C A, et a1. Biochemical, cellular and pharmacological aspects of the multidrug transporter[J]. Annu Rev Pharmacol Toxicol, 1999, 39:361-398.
[5] Undre N A, Stevenson P, Schafer A. Pharmacokinetics of tacrolimus: clinically relevant aspects[J]. Transplant Proc, 1999, 31(7A):21s.
[6] 史天陆，孙言才，沈爱宗，等. 他克莫司临床不良反应与防治[J].中国医院用药评价与分析, 2009, 9(1):67-69.
[7] 陈凡，徐彦贵. 他克莫司致器官移植后新发糖尿病机制研究进展[J]. 药品评价, 2014, 11(16):28-30.
[8] Ponseti J M, Gamez J, Azem J, et al. Tacrolimus for myasthenia gravis: a clinical study of 212 patients[J]. Ann N Y Acad Sci, 2008,1132(20):254-263.
[9] 陈玉萍，王卫，王中魁，等. 他克莫司治疗重症肌无力疗效及安全性评价[J]. 中华内科杂志，2013, 52(7):567-569.
2015, Vol. 13 
