Tacrolimus Drug Interactions

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I’m reporting LIVE from the American Society of Nephrology convention in Philadelphia, PA. I’ll be blogging from here as time & internet connectivity permit. The conference starts in earnest tomorrow morning.

Until then: common drug interactions for TACROLIMUS (Prograf):

1. Drugs which lower tacrolimus levels:
-anti-TB drugs (e.g., rifampin, rifabutin)
-anti-convulsants (e.g., barbituates, phenytoin)
-antibiotics (e.g., nafcillin, ciprofloxacin, imipenem, certain cephalosporins)
-other (e.g., St. John’s wort, antacids, ticlodipine, octreotide)

2. Drugs which raise tacrolimus levels:
-non-dihydropyridine calcium channel blockers (e.g., diltiazem, verapamil)
-antifungals (all azole derivatives)
-macrolide antibiotics (especially clarithromycin, erythromycin)
-protease inhibitors (for HIV)
-grapefruit juice

Also, the combination of either statins plus tacrolimus or fibrates + tacrolimus can cause an increased risk of rhabdomyolysis, so watch out for this. There is also an increased risk for hyperkalemia with the combination of ACE or ARB + tacrolimus.

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