Abstract
Sirolimus is used primarily to prevent rejection of solid organ grafts. This drug is a substrate for hepatic and intestinal cytochrome P450 3A4 isozyme (CYP3A4) and P-glycoprotein and is therefore susceptible to many drug interactions. Phenytoin is a strong inducer of CYP2C9, CYP2C19, and CYP3A4, so it may increase the hepatic metabolism of many medications. A case of phenytoin-induced decline in sirolimus levels is reported here.
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