Drug interactions
Chloramphenicol + Tacrolimus
Severity: Major
Chloramphenicol 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
Chloramphenicol has been reported to raise tacrolimus concentrations substantially. This can lead to nephrotoxicity, neurotoxicity and hyperglycemia.
What this interaction means in plain words
Chloramphenicol 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.
Chloramphenicol belongs to Anti Bacterial; Tacrolimus belongs to Miscellaneous.
Why it happens
Chloramphenicol inhibits CYP3A4 metabolism of tacrolimus, increasing its exposure.
What to do
Avoid if an alternative exists. Otherwise measure tacrolimus trough levels frequently, adjust the dose, and monitor renal function.
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 Chloramphenicol
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 Chloramphenicol with Tacrolimus?
MediHelp rates the interaction as major. Chloramphenicol 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. Chloramphenicol has been reported to raise tacrolimus concentrations substantially. This can lead to nephrotoxicity, neurotoxicity and hyperglycemia.
How serious is the interaction between Chloramphenicol 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: Avoid if an alternative exists. Otherwise measure tacrolimus trough levels frequently, adjust the dose, and monitor renal function.
What other medicines interact with Chloramphenicol?
MediHelp also lists interactions of Chloramphenicol with, for example, Adagrasib, Avapritinib, Bcg vaccine live. The full list is on the Chloramphenicol page.
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