Drug interactions
Fluvoxamine + Tacrolimus
Severity: Moderate
Fluvoxamine and Tacrolimus: moderate 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
Fluvoxamine can raise tacrolimus blood concentrations, increasing the risk of nephrotoxicity, neurotoxicity and hyperglycemia. Both drugs can also prolong the QT interval, so the combined effect on cardiac repolarization may add up.
What this interaction means in plain words
Fluvoxamine and Tacrolimus can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Fluvoxamine belongs to Central Nervous System; Tacrolimus belongs to Miscellaneous.
Why it happens
Fluvoxamine inhibits CYP3A4 and reduces tacrolimus metabolism, and both agents have additive QT-prolonging effects.
What to do
Monitor tacrolimus trough levels and renal function when starting or stopping fluvoxamine, and reduce the tacrolimus dose as needed. Obtain an ECG in patients with other QT risk factors.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Fluvoxamine
- Agomelatine + Fluvoxamine Contraindicated
- Alosetron + Fluvoxamine Contraindicated
- Fezolinetant + Fluvoxamine Contraindicated
- Fluvoxamine + Isocarboxazid Contraindicated
- Fluvoxamine + Mavacamten Contraindicated
- Fluvoxamine + Methylene blue 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 Fluvoxamine with Tacrolimus?
MediHelp rates the interaction as moderate. Fluvoxamine and Tacrolimus can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Fluvoxamine can raise tacrolimus blood concentrations, increasing the risk of nephrotoxicity, neurotoxicity and hyperglycemia. Both drugs can also prolong the QT interval, so the combined effect on cardiac repolarization may add up.
How serious is the interaction between Fluvoxamine and Tacrolimus?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor tacrolimus trough levels and renal function when starting or stopping fluvoxamine, and reduce the tacrolimus dose as needed. Obtain an ECG in patients with other QT risk factors.
What other medicines interact with Fluvoxamine?
MediHelp also lists interactions of Fluvoxamine with, for example, Agomelatine, Alosetron, Fezolinetant. The full list is on the Fluvoxamine page.
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