Date of report 23 Dec 2020
Reported case interaction between
Tenofovir-AF and Gentamicin
Tenofovir-AF and Gentamicin
Drugs suspected to be involved in the DDI
Complete list of drugs taken by the patient
gentamicin, valaciclovir, pantoprazole, olanzapine, fluconazole, citalopram, oxycodone, paracetamol, dexamethasone, cytarabine, carboplatin, piperacillin, tazobactam
Clinical case description
Patient on stable TAF-based antiretroviral treatment who developed proximal tubulopathy when treated with gentamicin for febrile neutropenia in the context of relapsed Hodgkin lymphoma. Within 24 h after starting gentamicin, piperacillin and tazobactam, the patient developed marked hypokalaemia, hypophosphatemia requiring intravenous replacement therapy. The patient had proteinuria, glycosuria and evidence of marked urinary elcetolyte wasting, consistent with acute proximal tubular dysfunction. Eleven days after stopping gentamicin, the serum biochemistry normalised. The urinary electrolyte wasting and proteinuria had improved and the glycosuria had resolved.
Clinical Outcome
Drug Interaction Probability Scale (DIPS)
Editorial Comment
Mitochondrial dysfunction has been associated with both aminoglycoside and tenofovir-asssociated nephrotoxicity so a synergistic mitochondrial toxicity could be a possible explanation for the occurrence of nephrotoxocity. In addition, sepsis and lymphopenia could potentially led to the accumulation of tenofovir (derived from TAF) and gentemicin in the proximal tubular cells thereby causing mitochondrial toxicity and proximal tubular dysfunction. This case has been published by Heron JE et al. BMC Nephrology 2020.
University of Liverpool Recommendation
No clinically significant interaction expected