Tacrolimus/Moderate and Weak CYP3A4 Inducers that Prolong QT Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Your other medicine may speed up how quickly your liver processes tacrolimus.Also, both drugs can affect your heart rhythm.

What might happen:

The amount of tacrolimus in your blood may decrease and it may not work as well.Also, taking these drugs together can affect your heart rhythm and increase your risk of an irregular heartbeat, which may be life-threatening.

What you should do about this interaction:

Make sure your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these two medicines together. Your doctor may need to check the amount of tacrolimus in your blood and adjust the dose until you have been stabilized on the combination.Contact your healthcare professional right away if you experience any chest discomfort, irregular heartbeat, dizziness or fainting.Your healthcare professionals (e.g. doctor or pharmacist) may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

  • 1.Prograf (tacrolimus) US prescribing information. Astellas Pharma US, Inc. August, 2023.
  • 2.Drew BJ, Ackerman MJ, Funk M, Gibler WB, Kligfield P, Menon V, Philippides GJ, Roden DM, Zareba W. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. J Am Coll Cardiol 2010 Mar 2;55(9):934-47.
  • 3.Wungwattana M, Savic M. Tacrolimus interaction with nafcillin resulting in significant decreases in tacrolimus concentrations: A case report. Transpl Infect Dis 2017 Apr;19(2):.
  • 4.Ikitimur B, Cosansu K, Karadag B, Cakmak HA, Avci BK, Erturk E, Seyahi N, Ongen Z. Long-Term Impact of Different Immunosuppressive Drugs on QT and PR Intervals in Renal Transplant Patients. Ann Noninvasive Electrocardiol 2015 Sep;20(5):426-32.
  • 5.USDepartment of Health and Human Services Food and Drug Administration. ICH E14 Clinical Evaluation of QT/QTc Interval Prolongation and Proarrhythmic Potential for Non-Antiarrhythmic Drugs. Available at: https://www.fda.gov/media/71372/download October, 2005.
  • 6.US Food and Drug Administration (FDA). Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers. Available at: https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and- drug-interactions-table-substrates-inhibitors-and-inducers. Updated 11/14/2017.
  • 7.This information is based on an extract from the Certara Drug Interaction Database (DIDB) Platform, Copyright Certara 1999-2023..

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.