Co-Administration of Mavacamten and Tacrolimus in a Renal Transplant Recipient With Obstructive Hypertrophic Cardiomyopathy.

Authors

Andrew Willeford, Arman Faravardeh, Jorge Silva Enciso, Quan M Bui

Published in

JACC. Case reports. Pages 110345. Sep 17, 2026. Epub Sep 17, 2026.

Abstract

Mavacamten is a cytochrome P450 (CYP)3A4 inducer with a product label recommending careful monitoring alongside CYP3A4 substrates. Data characterizing its interaction with tacrolimus, a narrow-therapeutic-index immunosuppressant and CYP3A4 substrate, are lacking.
A 62-year-old woman kidney transplant recipient with symptomatic obstructive hypertrophic cardiomyopathy was started on mavacamten 5 mg daily. Over 5 months, serial monitoring showed stable, therapeutic tacrolimus troughs (5.9-7.8 ng/mL) without dosage adjustments, alongside significant clinical improvement in obstructive symptoms.
This case uniquely details the longitudinal pharmacokinetic interaction between mavacamten and tacrolimus. This is highly relevant because pharmacokinetic models suggest CYP3A4 induction is dose-dependent; thus, safety demonstrated at 5 mg may not apply to higher regimens like 15 mg.
Low-dose mavacamten and tacrolimus coadministration is feasible. However, rigorous tacrolimus therapeutic drug monitoring remains essential, especially during mavacamten dose escalation.

PMID:
42853175
Bibliographic data and abstract were imported from PubMed on 09 Oct 2026.

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