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

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Obstructive hypertrophic cardiomyopathy (n=1). Intervention: Mavacamten. Primary outcome: Tacrolimus trough levels and clinical symptoms.

Q: What does this research mean for the field?

Coadministration of low-dose mavacamten (5 mg daily) with tacrolimus is clinically feasible without altering therapeutic tacrolimus trough concentrations. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Andrew Willeford; Arman Faravardeh; Jorge Silva Enciso; Quan M. Bui

doi:10.1016/j.jaccas.2026.110345

October 1, 2026JACC Case ReportsOpen Access

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

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Key result

Mavacamten coadministration maintains stable therapeutic tacrolimus levels in a kidney transplant recipient over 5 months.

n=1

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY 4.0

Why the study?

Data characterizing the interaction between mavacamten, a CYP3A4 inducer, and tacrolimus, a narrow-therapeutic-index CYP3A4 substrate, are lacking.

Key Points

To assess the pharmacokinetic interaction and clinical safety of co-administering mavacamten and tacrolimus in a renal transplant recipient with symptomatic obstructive hypertrophic cardiomyopathy.
Initiated mavacamten at 5 mg daily in a 62-year-old female renal transplant recipient receiving maintenance tacrolimus therapy.
Tracked serial tacrolimus trough concentrations and evaluated cardiac symptom changes over a 5-month longitudinal follow-up period.
Tacrolimus trough concentrations remained stable within the therapeutic range (5.9–7.8 ng/mL) across 5 months without requiring dosage adjustments.
The patient experienced substantial clinical improvement in obstructive hypertrophic cardiomyopathy symptoms with preserved renal allograft stability.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 62-year-old female kidney transplant recipient with symptomatic obstructive hypertrophic cardiomyopathy treated with mavacamten and tacrolimus, followed for 5 months.

I

Intervention

Mavacamten 5 mg daily co-administered with tacrolimus

O

Outcome

Tacrolimus trough levels and clinical improvement in obstructive symptomssafety

Low-dose mavacamten (5 mg daily) and tacrolimus co-administration appears clinically feasible without disrupting therapeutic tacrolimus levels, though close monitoring remains essential.

Limitations

Safety demonstrated at 5 mg may not apply to higher regimens like 15 mg due to dose-dependent CYP3A4 induction.

Implication

Stable tacrolimus levels with mavacamten in one case; leaves open need for systematic interaction studies before changing monitoring.

Abstract

BACKGROUND: 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. CASE SUMMARY: 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. DISCUSSION: 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. TAKE-HOME MESSAGES: Low-dose mavacamten and tacrolimus coadministration is feasible. However, rigorous tacrolimus therapeutic drug monitoring remains essential, especially during mavacamten dose escalation.

Discussion

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Cite This Study

Willeford et al. (2026) conducted a case report in Obstructive hypertrophic cardiomyopathy (n=1). Mavacamten was evaluated on Tacrolimus trough levels and clinical symptoms. Coadministration of mavacamten 5 mg daily and tacrolimus in a kidney transplant recipient maintained stable therapeutic tacrolimus troughs (5.9-7.8 ng/mL) over 5 months.

synapsesocial.com/papers/6acae65a082e6266f39bf5f6 https://doi.org/10.1016/j.jaccas.2026.110345

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

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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