Drug interactions
Itraconazole + Tacrolimus
Severity: Major
Itraconazole 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
Itraconazole raises tacrolimus concentrations considerably, leading to nephrotoxicity, neurotoxicity and other adverse effects. Both drugs can also prolong the QT interval.
What this interaction means in plain words
Itraconazole 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.
Itraconazole belongs to Anti Fungals; Tacrolimus belongs to Miscellaneous.
Why it happens
Itraconazole inhibits CYP3A4 and P-glycoprotein, decreasing tacrolimus clearance, with additive QT effects.
What to do
Reduce the tacrolimus dose when starting itraconazole and monitor trough levels and renal function frequently. Check ECG and electrolytes, and readjust the dose when itraconazole 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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References
Other interactions of Itraconazole
- Alfuzosin + Itraconazole Contraindicated
- Alprazolam + Itraconazole Contraindicated
- Avanafil + Itraconazole Contraindicated
- Conivaptan + Itraconazole Contraindicated
- Dihydroergotamine intranasal + Itraconazole Contraindicated
- Dihydroergotamine + Itraconazole 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 Itraconazole with Tacrolimus?
MediHelp rates the interaction as major. Itraconazole 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. Itraconazole raises tacrolimus concentrations considerably, leading to nephrotoxicity, neurotoxicity and other adverse effects. Both drugs can also prolong the QT interval.
How serious is the interaction between Itraconazole 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 when starting itraconazole and monitor trough levels and renal function frequently. Check ECG and electrolytes, and readjust the dose when itraconazole is stopped.
What other medicines interact with Itraconazole?
MediHelp also lists interactions of Itraconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Itraconazole page.
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