case report
2 interactions related to case report
pomelo + tacrolimus
Pomelo contains furanocoumarins that inhibit intestinal CYP3A4 and P-glycoprotein, the systems that limit how much tacrolimus is absorbed. A documented case in a renal transplant patient showed pomelo consumption raised tacrolimus blood levels, and tacrolimus has a narrow therapeutic window where small swings can cause kidney or nervous-system toxicity, or under-immunosuppression and rejection.
star fruit + phenytoin
Star fruit (Averrhoa carambola) contains caramboxin, a neurotoxin that excites neurons, plus soluble oxalates that can injure the kidneys. In people with reduced kidney function, who cannot clear caramboxin, eating star fruit has triggered intractable seizures and status epilepticus. This is the fruit's own toxicity rather than a chemical reaction with phenytoin, but for someone taking phenytoin to prevent seizures it adds a serious, avoidable risk.