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The pharmacological management of depression in patients who have undergone organ transplantation is especially challenging given multiple medications, the pharmacokinetic and pharmacodynamic complexities associated with organ failure, and the narrow therapeutic index of immunosuppressants such as cyclosporine and tacrolimus.^1-2 Changes in levels of immunosuppressant medication may not only result in serious toxic effects, but also in changes in the degree of immunosuppression, with low immunosuppressant levels putting the patient at greater risk of rejection.

We report the first case of tacrolimus toxicity associated with the use of the antidepressant nefazodone, a known inhibitor of the cytochrome P450 3A4 isoenzyme.

Report of a Case

A 16-year-old white adolescent boy with a history of chronic renal failure secondary to familial membranoproliferative glomerulonephritis and successful cadaveric renal transplantation was hospitalized with apparent delirium and renal failure. He had begun taking nefazodone 4 weeks earlier at a dose of 150 mg/d for depression with active suicidal ideation and . . . [Full Text of this Article]

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