Drug interactions
Colistin + Tacrolimus
Severity: Major
Colistin and Tacrolimus: major 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
Both colistin and tacrolimus are nephrotoxic, and tacrolimus also causes neurotoxicity. Together they can increase the risk of acute kidney injury, which may in turn raise tacrolimus exposure.
What this interaction means in plain words
Colistin 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.
Colistin belongs to Anti Bacterial; Tacrolimus belongs to Miscellaneous.
Why it happens
Additive nephrotoxicity, with tacrolimus causing renal afferent vasoconstriction and colistin causing direct tubular injury.
What to do
Monitor serum creatinine and tacrolimus trough levels frequently and adjust the tacrolimus dose accordingly. Limit colistin duration and dose to 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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Other interactions of Colistin
- Colistin + Polymyxin b Contraindicated
- Amikacin + Colistin Major
- Amphotericin b deoxycholate + Colistin Major
- Amphotericin b + Colistin Major
- Atracurium + Colistin Major
- Bacitracin + Colistin Major
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 Colistin with Tacrolimus?
MediHelp rates the interaction as major. Colistin 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. Both colistin and tacrolimus are nephrotoxic, and tacrolimus also causes neurotoxicity. Together they can increase the risk of acute kidney injury, which may in turn raise tacrolimus exposure.
How serious is the interaction between Colistin 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: Monitor serum creatinine and tacrolimus trough levels frequently and adjust the tacrolimus dose accordingly. Limit colistin duration and dose to renal function.
What other medicines interact with Colistin?
MediHelp also lists interactions of Colistin with, for example, Polymyxin b, Amikacin, Amphotericin b deoxycholate. The full list is on the Colistin page.
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