Drug interactions
Erythromycin ethylsuccinate + Tacrolimus
Severity: Major
Erythromycin ethylsuccinate 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 inhibits CYP3A4 and can substantially raise tacrolimus levels, causing nephrotoxicity and neurotoxicity. Both drugs also prolong the QT interval.
What this interaction means in plain words
Erythromycin ethylsuccinate 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.
Why it happens
CYP3A4 and P-glycoprotein inhibition by erythromycin reduces tacrolimus clearance, along with additive QT prolongation.
What to do
Use a different antibiotic class where possible. If it must be used, lower the tacrolimus dose, monitor trough levels and creatinine, and check the 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 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 ethylsuccinate with Tacrolimus?
MediHelp rates the interaction as major. Erythromycin ethylsuccinate 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 inhibits CYP3A4 and can substantially raise tacrolimus levels, causing nephrotoxicity and neurotoxicity. Both drugs also prolong the QT interval.
How serious is the interaction between Erythromycin ethylsuccinate 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 a different antibiotic class where possible. If it must be used, lower the tacrolimus dose, monitor trough levels and creatinine, and check the ECG.
What other medicines interact with Tacrolimus?
MediHelp also lists interactions of Tacrolimus with, for example, Adenovirus types 4 and 7 live, Bcg vaccine live, Cidofovir. The full list is on the Tacrolimus page.
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