Drug interactions
Azithromycin + Tacrolimus
Severity: Moderate
Azithromycin and Tacrolimus: moderate interaction.
Last updated
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
Tacrolimus can prolong the QT interval, and azithromycin adds to this effect. Azithromycin may also modestly raise tacrolimus concentrations, although this is much less than with other macrolides.
What this interaction means in plain words
Azithromycin and Tacrolimus can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Azithromycin belongs to Anti Bacterial; Tacrolimus belongs to Miscellaneous.
Why it happens
Additive QTc prolongation, with possible weak P-gp or CYP3A inhibition by azithromycin raising tacrolimus levels.
What to do
Monitor tacrolimus trough levels and renal function when azithromycin is started or stopped. Obtain an ECG and correct electrolytes in patients with QT risk factors.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Azithromycin
- Azithromycin + Cisapride Contraindicated
- Azithromycin + Domperidone Contraindicated
- Azithromycin + Dronedarone Contraindicated
- Azithromycin + Pimozide Contraindicated
- Azithromycin + Piperaquine Contraindicated
- Azithromycin + Thioridazine Contraindicated
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
Frequently asked questions
Can I take Azithromycin with Tacrolimus?
MediHelp rates the interaction as moderate. Azithromycin and Tacrolimus can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Tacrolimus can prolong the QT interval, and azithromycin adds to this effect. Azithromycin may also modestly raise tacrolimus concentrations, although this is much less than with other macrolides.
How serious is the interaction between Azithromycin and Tacrolimus?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor tacrolimus trough levels and renal function when azithromycin is started or stopped. Obtain an ECG and correct electrolytes in patients with QT risk factors.
What other medicines interact with Azithromycin?
MediHelp also lists interactions of Azithromycin with, for example, Cisapride, Domperidone, Dronedarone. The full list is on the Azithromycin page.
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