Drug interactions
Atazanavir + Tacrolimus
Severity: Major
Atazanavir and Tacrolimus: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Atazanavir inhibits CYP3A4 and can markedly raise tacrolimus concentrations. This may cause nephrotoxicity, neurotoxicity and other toxicity.
What this interaction means in plain words
Atazanavir and Tacrolimus can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Atazanavir belongs to Anti Virals; Tacrolimus belongs to Miscellaneous.
Why it happens
Atazanavir inhibits CYP3A4, reducing tacrolimus metabolism.
What to do
Reduce the tacrolimus dose and extend the dosing interval on starting atazanavir, with frequent trough level and renal function monitoring. Readjust after atazanavir is stopped.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Tacrolimus
- Adenovirus types 4 and 7 live + Tacrolimus Contraindicated
- Bcg vaccine live + Tacrolimus Contraindicated
- Cidofovir + Tacrolimus Contraindicated
- Cyclosporin + Tacrolimus Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Tacrolimus Contraindicated
- Measles mumps and rubella vaccine live + Tacrolimus Contraindicated
Other interactions of Atazanavir
- Alfuzosin + Atazanavir Contraindicated
- Atazanavir + Avanafil Contraindicated
- Atazanavir + Dronedarone Contraindicated
- Atazanavir + Eletriptan Contraindicated
- Atazanavir + Eplerenone Contraindicated
- Atazanavir + Ergotamine Contraindicated
Frequently asked questions
Can I take Atazanavir with Tacrolimus?
MediHelp rates the interaction as major. Atazanavir and Tacrolimus can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Atazanavir inhibits CYP3A4 and can markedly raise tacrolimus concentrations. This may cause nephrotoxicity, neurotoxicity and other toxicity.
How serious is the interaction between Atazanavir and Tacrolimus?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reduce the tacrolimus dose and extend the dosing interval on starting atazanavir, with frequent trough level and renal function monitoring. Readjust after atazanavir is stopped.
What other medicines interact with Tacrolimus?
MediHelp also lists interactions of Tacrolimus with, for example, Adenovirus types 4 and 7 live, Bcg vaccine live, Cidofovir. The full list is on the Tacrolimus page.
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