Organ transplantation, immunosuppressant therapy, and management dilemma in drug-induced psychiatric manifestations: Lessons learned from a case report

Abstract

Solid organ transplantation is the intervention of choice for end-stage renal disease burdening the patient and care givers. Posttransplant patients receive immunosuppression therapy to prevent graft rejection which might lead to psychiatric side effects induced by the drugs, which require psychotropics for symptomatic relief. We present the case of a young man who developed tacrolimus-induced psychosis and management dilemma due to the drug interactions. Risperidone or haloperidol, which is usually given for acute management of psychotic symptoms, is contraindicated due to the interactions with immunosuppressant therapy. In consultation-liaison psychiatry, it is imperative to know the interactions between psychotropics and transplant medications. We also discuss in detail the posttransplant psychiatric conditions and safer alternative psychotropics for different psychiatric conditions in view of potential drug-drug interaction of other medications with that of immunosuppressants.