Cannabidiol (CBD) oil and tacrolimus: the unexpected high in renal transplant recipients – case series and review
Mrinalini sarkar1, Sabrina Lee2, Natalie Bjelajac 3, Suphamai Bunnapradist1, Erik Lum 1.
1Division of Nephrology, UCLA -David Geffen School of Medicine, Los Angeles, CA, United States; 2Department of Pharmacy Services, UCLA -Ronald Reagan Medical Centre, Los Angeles, CA, United States; 3Connie Frank Transplant Centre, UCLA -Ronald Reagan Medical Centre, Los Angeles, CA, United States
Introduction: Calcineurin inhibitor (CNI) based regimens afford the greatest protection against acute rejection and are used in > 90% of kidney transplant recipients. Cannabidiol (CBD) has been advertised as a natural remedy to treat several disorders. Information on the concurrent use of CBD and tacrolimus is limited. Herein we describe four cases of patients reporting CBD use post kidney transplant, and the effects on tacrolimus drug levels.
Discussion: Cannabidiol (CBD) is a non-psychogenic cannabinoid found in the Cannibis sativa plant. The Agriculture Improvement Act of 2018 legalized production of industrial hemp plants, so long as it contained no more than 0.3% of delta-9-tetrahydrocannabinol (THC).Interestingly, amongst our cases 3 resulted in an increase in tacrolimus levels and another resulted in a marked decrease in tacrolimus levels which precipitated allograft rejection. all cases of increased levels occurred without a change in tacrolimus dosing and relative stable levels prior to known administration. Tacrolimus levels improved after stopping CBD oil supplements. The solitary case of reduced tacrolimus levels following CBD oil exposure i may have been related to another compound within the CBD oil labelled product.
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