Tacrolimus

Do not give Clarithromycin to those on Tacrolimus which can cause toxicity. Oral tacrolimus products: prescribe and dispense by brand name only, to minimise the risk of inadvertent switching between products, which has been associated with reports of toxicity and graft rejection

About : Always check the BNF link here

Mode of action

• inhibiting the production of interleukin-2

Indications/Dose

• Prevent organ rejection in transplantation: Liver and Kidney
• Dose depends on the formulation used - see BNF
• Ulcerative colitis, T mediated diseases
• Topical use for Dermatological use: e.g. severe eczema

Interactions

• Because the drug is highly red blood cell and protein-bound, increased efficacy/toxicity for a given whole blood concentration will occur if there is anaemia or hypoalbuminaemia.

Increase Ciclosporin levels

• Amiodarone , Fluconazole (> 200 mg/day), anti-retroviral therapy
• Clarithromycin, itraconazole, Ketoconazole, danazol
• Diltiazem, nicardipine, progestogens, Erythromycin
• Telaprevir/boceprevir

Reduce Ciclosprin levels

• Carbamazepine, caspofungin, phenytoin, primidone
• Griseofulvin, rifampicin, phenobarbitone

Cautions

• See BNF

Contraindications

• See BNF

Side effects

• Headaches, paraesthesia, tremor, fits, nausea, vomiting, diarrhoea
• Hypertension, hyperkalaemia, renal impairment, arthralgia, diabetes mellitus
• Ciclosporin and tacrolimus can cause hyperkalaemia and hypomagnesaemia, with or without renal impairment.

References

• Tacrolimus BNF