Drug interactions
Indinavir + Tacrolimus
Severity: Major
Indinavir and Tacrolimus: major 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
Indinavir inhibits CYP3A4 and P-glycoprotein and can markedly increase tacrolimus blood concentrations. This raises the risk of nephrotoxicity, neurotoxicity and other toxicity.
What this interaction means in plain words
Indinavir 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
Inhibition of CYP3A4 and P-glycoprotein by indinavir decreases tacrolimus metabolism and efflux.
What to do
Reduce the tacrolimus dose substantially and extend dosing interval when starting indinavir, guided by frequent trough levels. Monitor renal function and re-adjust when indinavir is stopped.
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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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 Indinavir with Tacrolimus?
MediHelp rates the interaction as major. Indinavir 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. Indinavir inhibits CYP3A4 and P-glycoprotein and can markedly increase tacrolimus blood concentrations. This raises the risk of nephrotoxicity, neurotoxicity and other toxicity.
How serious is the interaction between Indinavir 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: Reduce the tacrolimus dose substantially and extend dosing interval when starting indinavir, guided by frequent trough levels. Monitor renal function and re-adjust when indinavir is stopped.
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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