Drug interactions
Dexamethasone-tobramycin + Tacrolimus
Severity: Major
Dexamethasone-tobramycin and Tacrolimus: major interaction.
Last updated Sources: UK SmPC
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 and tobramycin are both nephrotoxic and ototoxic, so systemic exposure to both raises the risk of kidney injury. Dexamethasone may also lower tacrolimus concentrations through CYP3A4 induction, risking under-immunosuppression.
What this interaction means in plain words
Dexamethasone-tobramycin 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.
Dexamethasone-tobramycin belongs to Anti Bacterial; Tacrolimus belongs to Miscellaneous.
Why it happens
Additive nephrotoxicity and ototoxicity, plus dexamethasone-mediated CYP3A4 induction of tacrolimus metabolism.
What to do
Monitor serum creatinine and tacrolimus trough levels closely, adjusting the tacrolimus dose as needed. Limit aminoglycoside duration and monitor tobramycin levels if given systemically.
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 Dexamethasone-tobramycin
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 Dexamethasone-tobramycin with Tacrolimus?
MediHelp rates the interaction as major. Dexamethasone-tobramycin 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. Tacrolimus and tobramycin are both nephrotoxic and ototoxic, so systemic exposure to both raises the risk of kidney injury. Dexamethasone may also lower tacrolimus concentrations through CYP3A4 induction, risking under-immunosuppression.
How serious is the interaction between Dexamethasone-tobramycin 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 closely, adjusting the tacrolimus dose as needed. Limit aminoglycoside duration and monitor tobramycin levels if given systemically.
What other medicines interact with Dexamethasone-tobramycin?
MediHelp also lists interactions of Dexamethasone-tobramycin with, for example, Capreomycin, Carboplatin, Ciprofloxacin. The full list is on the Dexamethasone-tobramycin page.
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