Drug interactions
Erythromycin + Tacrolimus
Severity: Major
Erythromycin 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
Erythromycin can substantially raise tacrolimus concentrations, resulting in nephrotoxicity, neurotoxicity and QT prolongation. Tacrolimus has a narrow therapeutic index.
What this interaction means in plain words
Erythromycin 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.
Erythromycin belongs to Anti Bacterial; Tacrolimus belongs to Miscellaneous.
Why it happens
Inhibition of CYP3A4 and P-glycoprotein by erythromycin reduces tacrolimus clearance, with additive QT effects.
What to do
Use an alternative antibiotic where possible. If erythromycin is required, monitor tacrolimus trough levels and renal function, reduce the dose as needed, and check ECG.
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 Erythromycin
- Conivaptan + Erythromycin Contraindicated
- Dihydroergotamine intranasal + Erythromycin Contraindicated
- Dihydroergotamine + Erythromycin Contraindicated
- Domperidone + Erythromycin Contraindicated
- Dronedarone + Erythromycin Contraindicated
- Droperidol + Erythromycin 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 Erythromycin with Tacrolimus?
MediHelp rates the interaction as major. Erythromycin 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. Erythromycin can substantially raise tacrolimus concentrations, resulting in nephrotoxicity, neurotoxicity and QT prolongation. Tacrolimus has a narrow therapeutic index.
How serious is the interaction between Erythromycin 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: Use an alternative antibiotic where possible. If erythromycin is required, monitor tacrolimus trough levels and renal function, reduce the dose as needed, and check ECG.
What other medicines interact with Erythromycin?
MediHelp also lists interactions of Erythromycin with, for example, Conivaptan, Dihydroergotamine intranasal, Dihydroergotamine. The full list is on the Erythromycin page.
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