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Tacrolimus
MEDICATION TYPE
Immunosuppressant
INDICATIONS
Post-transplant immunosuppression.
DRUG INTERACTIONS
Aminoglycosides
Increased risk of nephrotoxicity.
Amphotericin
Increased risk of nephrotoxicity.
Calcium channel blockers
Increase plasma concentration of tacrolimus.
Caspofungin
Decreases tacrolimus plasma concentration.
Chloramphenicol
Increases tacrolimus concentration.
Clarithromycin, Erythromycin
Increases tacrolimus concentration.
Cyclosporin
Increased cyclosporin half life resulting in increased risk of toxicity.
Fluconazole (and other imidazoles)
Increase tacrolimus level.
NSAID including Ibuprofen
Increased risk of nephrotoxicity.
Omeprazole
Increases tacrolimus level.
Oral contraceptive
Reduces efficacy of pill.
Potassium sparing diuretics
Increased risk of hyperkaleamia.
Rifampicin
Decreases tacrolimus concentration.
St Johns Wort
Decreases tacrolimus level, avoid concomitant use.
NOTES
TDM essential. Brand-specific prescribing. Many CYP3A4 interactions.
MEDICAL WARNING
Tacrolimus should only be administered under the supervision of a healthcare professional. Always verify against current BNF and your local CF protocol before prescribing.