Drug interactions
Ivosidenib + Tacrolimus
Severity: Major
Ivosidenib 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
Both drugs can prolong the QT interval, and ivosidenib also induces CYP3A4, which can lower tacrolimus exposure. This raises the risk of arrhythmia as well as of subtherapeutic immunosuppression and rejection.
What this interaction means in plain words
Ivosidenib 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.
Ivosidenib belongs to Oncology; Tacrolimus belongs to Miscellaneous.
Why it happens
Additive QT prolongation, plus ivosidenib induction of CYP3A4 increasing tacrolimus metabolism.
What to do
Monitor ECG and electrolytes, and measure tacrolimus trough concentrations frequently, increasing the dose as needed. Consider alternatives if the QTc becomes prolonged.
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
Other interactions of Ivosidenib
- Alfuzosin + Ivosidenib Major
- Amiodarone + Ivosidenib Major
- Amisulpride + Ivosidenib Major
- Amitriptyline + Ivosidenib Major
- Amobarbital + Ivosidenib Major
- Anagrelide + Ivosidenib Major
Frequently asked questions
Can I take Ivosidenib with Tacrolimus?
MediHelp rates the interaction as major. Ivosidenib 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. Both drugs can prolong the QT interval, and ivosidenib also induces CYP3A4, which can lower tacrolimus exposure. This raises the risk of arrhythmia as well as of subtherapeutic immunosuppression and rejection.
How serious is the interaction between Ivosidenib 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: Monitor ECG and electrolytes, and measure tacrolimus trough concentrations frequently, increasing the dose as needed. Consider alternatives if the QTc becomes prolonged.
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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