ABSTRACT
I. INTRODUCTION Many adverse reactions are seen with the immunosuppressive agents commonly used in transplantation. However, hepatotoxicity is infrequently reported. Of greater concern are the many drug interactions associated with immunosuppressive agents. Drug interactions are particularly common in patients receiving cyclosporin, tacrolimus, or sirolimus. Each of these agents is metabolized by the cytochrome P450 IIIA enzyme (CYP3A) in the liver and small intestine (1-4). In addition, they are all substrates for p-glycoprotein (a
634 Hebert et al.
