The pharmacological management of depression in patients who have undergone organ transplantation is especially challenging given multiple medications, the pharmacokinetic and pharmacodynamic complexities associated with organ failure, and the narrow therapeutic index of immunosuppressants such as cyclosporine and tacrolimus.1,2 Changes in levels of immunosuppressant medication may not only result in serious toxic effects, but also in changes in the degree of immunosuppression, with low immunosuppressant levels putting the patient at greater risk of rejection.
Campo JV, Smith C, Perel JM. Tacrolimus Toxic Reaction Associated With the Use of Nefazodone: Paroxetine as an Alternative Agent. Arch Gen Psychiatry. 1998;55(11):1050-1052. doi: