Selected Immunosuppressants;Temsirolimus/Selected Macrolides 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:

Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

When these two medicines are taken together, your body may not be able to process your immunosuppressant, temsirolimus, or your antibiotic properly.

What might happen:

Your blood levels of your medicines may increase and cause toxic side effects.

What you should do about this interaction:

Make sure your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. Your doctor may want to check the amount of medicine in your blood and may want to change the amount of medicine you take. Let your doctor know if you experience a decrease in the amount of urine you make or if you experience bloody urine, frequent urges to urinate, headache, dizziness or blurred vision.Your healthcare professionals (e.g. doctor or pharmacist) may already be aware of this interaction and may be monitoring you for it. If your doctor prescribes these medicines together, it may be necessary to adjust the dose of tacrolimus or change you to a different medicine. Do not start, stop, or change the dosage of any medicine before checking with them first.

  • 1.Rapamune (sirolimus) US prescribing information. Wyeth Pharmaceuticals Aug, 2022.
  • 2.Kovarik JM, Beyer D, Bizot MN, Jiang Q, Shenouda M, Schmouder RL. Effect of multiple-dose erythromycin on everolimus pharmacokinetics. Eur J Clin Pharmacol 2005 Mar;61(1):35-8.
  • 3.Claesson K, Brattstrom C, Burke JT. Sirolimus and erythromycin interaction: two cases. Transplant Proc 2001 May;33(3):2136.
  • 4.Torisel (temsirolimus) US prescribing information. Wyeth Pharmaceuticals, Inc. March, 2018.
  • 5.Danan G, Descatoire V, Pessayre D. Self-induction by erythromycin of its own transformation into a metabolite forming an inactive complex with reduced cytochrome P-450. J Pharmacol Exp Ther 1981 Aug;218(2):509-14.
  • 6.Ptachcinski RJ, Carpenter BJ, Burckart GJ, Venkataramanan R, Rosenthal JT. Effect of erythromycin on cyclosporine levels. N Engl J Med 1985 Nov 28; 313(22):1416-7.
  • 7.Kohan DE. Possible interaction between cyclosporine and erythromycin. N Engl J Med 1986 Feb 13;314(7):448.
  • 8.Martell R, Heinrichs D, Stiller CR, Jenner M, Keown PA, Dupre J. The effects of erythromycin in patients treated with cyclosporine. Ann Intern Med 1986 May;104(5):660-1.
  • 9.Grino JM, Sabate J, Castelao AM, Guardia M, Seron D, Alsina J. Erythromycin and cyclosporine. Ann Intern Med 1986 Sep;105(3):467-8.
  • 10.Godin JR, Sketris IS, Belitsky P. Erythromycin-cyclosporin interaction. Drug Intell Clin Pharm 1986 Jun;20(6):504-5.
  • 11.Kessler M, Louis J, Renoult E, Vigneron B, Netter P. Interaction between cyclosporin and erythromycin in a kidney transplant patient. Eur J Clin Pharmacol 1986;30(5):633-4.
  • 12.Gonwa TA, Nghiem DD, Schulak JA, Corry RJ. Erythromycin and cyclosporine. Transplantation 1986 Jun;41(6):797-9.
  • 13.Freeman DJ, Martell R, Carruthers SG, Heinrichs D, Keown PA, Stiller CR. Cyclosporin-erythromycin interaction in normal subjects. Br J Clin Pharmacol 1987 Jun;23(6):776-8.
  • 14.Aoki FY, Yatscoff R, Jeffery J, Rush D, Sitar D. Effects of erythromycin on cyclosporine A kinetics in renal transplant patients. Clin Pharmacol Ther 1987 Feb;41(2):221.
  • 15.Wadhwa NK, Schroeder TJ, O'Flaherty E, Pesce AJ, Myre SA, Munda R, First MR. Interaction between erythromycin and cyclosporine in a kidney and pancreas allograft recipient. Ther Drug Monit 1987;9(1):123-5.
  • 16.Vereerstraeten P, Thiry P, Kinnaert P, Toussaint C. Influence of erythromycin on cyclosporine pharmacokinetics. Transplantation 1987 Jul; 44(1):155-6.
  • 17.Harnett JD, Parfrey PS, Paul MD, Gault MH. Erythromycin-cyclosporine interaction in renal transplant recipients. Transplantation 1987 Feb; 43(2):316-8.
  • 18.Jensen CW, Flechner SM, Van Buren CT, Frazier OH, Cooley DA, Lorber MI, Kahan BD. Exacerbation of cyclosporine toxicity by concomitant administration of erythromycin. Transplantation 1987 Feb;43(2):263-70.
  • 19.Murray BM, Edwards L, Morse GD, Kohli RR, Venuto RC. Clinically important interaction of cyclosporine and erythromycin. Transplantation 1987 Apr; 43(4):602-4.
  • 20.Gupta SK, Bakran A, Johnson RW, Rowland M. Erythromycin enhances the absorption of cyclosporin. Br J Clin Pharmacol 1988 Mar;25(3):401-2.
  • 21.Ben-Ari J, Eisenstein B, Davidovits M, Shmueli D, Shapira Z, Stark H. Effect of erythromycin on blood cyclosporine concentrations in kidney transplant patients. J Pediatr 1988 Jun;112(6):992-3.
  • 22.Lysz K, Rosenberg JC, Kaplan MP, Migdal S, Sillix D. Interaction of erythromycin with cyclosporine. Transplant Proc 1988 Apr;20(2 Suppl 2):543-8.
  • 23.Guillemain R, Billaud E, Dreyfus G, Amrein C, Kitzis M, Jebara VA, Kreft-Jais C. The effects of spiramycin on plasma cyclosporin A concentrations in heart transplant patients. Eur J Clin Pharmacol 1989; 36(1):97-8.
  • 24.Gupta SK, Bakran A, Johnson RW, Rowland M. Cyclosporin-erythromycin interaction in renal transplant patients. Br J Clin Pharmacol 1989 Apr; 27(4):475-81.
  • 25.Vernillet L, Bertault-Peres P, Berland Y, Barradas J, Durand A, Olmer M. Lack of effect of spiramycin on cyclosporin pharmacokinetics. Br J Clin Pharmacol 1989 Jun;27(6):789-94.
  • 26.Marre F, de Sousa G, Orloff AM, Rahmani R. In vitro interaction between cyclosporin A and macrolide antibiotics. Br J Clin Pharmacol 1993 Apr; 35(4):447-8.
  • 27.Moral A, Navasa M, Rimola A, Garcia-Valdecasas JC, Grande L, Visa J, Rodes J. Erythromycin ototoxicity in liver transplant patients. Transpl Int 1994;7(1):62-4.
  • 28.Koselj M, Bren A, Kandus A, Kovac D. Drug interactions between cyclosporine and rifampicin, erythromycin, and azoles in kidney recipients with opportunistic infections. Transplant Proc 1994 Oct; 26(5):2823-4.
  • 29.Zylber-Katz E. Multiple drug interactions with cyclosporine in a heart transplant patient. Ann Pharmacother 1995 Feb;29(2):127-31.
  • 30.Kessler M, Netter P, Zerrouki M, Renoult E, Trechot P, Dousset B, Jonon B, Mur JM. Spiramycin does not increase plasma cyclosporin concentrations in renal transplant patients. Eur J Clin Pharmacol 1988;35(3):331-2.
  • 31.Kessler M, Netter P, Renoul HE, Trechot P, Dousset B, Bannwarth B. Lack of effect of spiramycin on cyclosporin pharmacokinetics. Br J Clin Pharmacol 1990 Mar;29(3):370-1.
  • 32.Birmele B, Lebranchu Y, Beliveau F, Rateau H, Furet Y, Nivet H, Bagros P. Absence of interaction between cyclosporine and spiramycin. Transplantation 1989 May;47(5):927-8.
  • 33.Gersema LM, Porter CB, Russell EH. Suspected drug interaction between cyclosporine and clarithromycin. J Heart Lung Transplant 1994 Mar-Apr; 13(2):343-5.
  • 34.Ferrari SL, Goffin E, Mourad M, Wallemacq P, Squifflet JP, Pirson Y. The interaction between clarithromycin and cyclosporine in kidney transplant recipients. Transplantation 1994 Sep 27;58(6):725-7.
  • 35.Ljutic D, Rumboldt Z. Possible interaction between azithromycin and cyclosporin: a case report. Nephron 1995;70(1):130.
  • 36.Sparkes T, Lemonovich TL. Interactions between anti-infective agents and immunosuppressants-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019 Feb 28;e13510.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

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.