There is an interaction between tacrolimus(TAC) and glucocorticoids where glucocorticoids is a known CYP3A4 and P-gp inducer.However, the dose of glucocorticoids reported is low but not pulse therapy.We retrospectively studied 63 renal transplant recipients receiving TAC after transplantation.All the patients were classified as 500 mg(POD 1–3), 30 mg(POD 4–10), 25 mg(POD 11–17), 20 mg(POD 18–24), 15 mg(POD 25–31), 10 mg(POD 32–60) and 10 mg(POD 61–90).We recorded daily data for each patient from the day of transplantation until POD 90.There was no difference in TAC blood levels within the 3 months after transplantation in the glucocorticoids groups.However, the average daily dose of TAC was significantly lower by weekly reductions of 5 mg dose.The TAC daily dose was not changed from POD 1–4, but the blood concentrations of TAC were significantly lower after the glucocorticoid dose was changed from 500 mg to 30 mg.We demonstrated the induction effect of low-dose glucocorticoids on TAC in renal transplant recipients, and found that the high-dose of glucocorticoids might play a role in substrate competition.We proposed that monitoring of the blood concentrations of TAC was needed when the glucocorticoid dose was changed in the patient undergoing renal transplantation.
