Drug interactions
Diflunisal + Tacrolimus
Severity: Major
Diflunisal and Tacrolimus: major interaction.
Last updated Sources: EMA 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
Combining an NSAID such as diflunisal with tacrolimus increases the risk of acute kidney injury and hyperkalemia. Both drugs reduce renal blood flow, so the effect can be additive, particularly in transplant recipients.
What this interaction means in plain words
Diflunisal 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.
Diflunisal belongs to Musculoskeletal; Tacrolimus belongs to Miscellaneous.
Why it happens
Additive renal vasoconstriction from calcineurin inhibition and NSAID suppression of vasodilatory prostaglandins.
What to do
Avoid NSAIDs in patients on tacrolimus where possible and use paracetamol or another alternative. If used, give the shortest course and monitor serum creatinine, potassium and tacrolimus trough levels.
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 Diflunisal
- Diflunisal + Ketorolac Contraindicated
- Diflunisal + Ketorolac intranasal Contraindicated
- Acemetacin + Diflunisal Major
- Acetazolamide + Diflunisal Major
- Alteplase + Diflunisal Major
- Amiloride + Diflunisal 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 Diflunisal with Tacrolimus?
MediHelp rates the interaction as major. Diflunisal 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. Combining an NSAID such as diflunisal with tacrolimus increases the risk of acute kidney injury and hyperkalemia. Both drugs reduce renal blood flow, so the effect can be additive, particularly in transplant recipients.
How serious is the interaction between Diflunisal 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 NSAIDs in patients on tacrolimus where possible and use paracetamol or another alternative. If used, give the shortest course and monitor serum creatinine, potassium and tacrolimus trough levels.
What other medicines interact with Diflunisal?
MediHelp also lists interactions of Diflunisal with, for example, Ketorolac, Ketorolac intranasal, Acemetacin. The full list is on the Diflunisal page.
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