Drug interactions
Ketoconazole + Tacrolimus
Severity: Major
Ketoconazole 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
Ketoconazole substantially increases tacrolimus blood concentrations, risking nephrotoxicity, neurotoxicity, hyperkalemia and QT prolongation. The effect can develop quickly and persist after ketoconazole is stopped.
What this interaction means in plain words
Ketoconazole 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.
Ketoconazole belongs to Anti Fungals; Tacrolimus belongs to Miscellaneous.
Why it happens
Inhibition of CYP3A4 and P-glycoprotein reduces intestinal and hepatic clearance of tacrolimus.
What to do
If coadministration is necessary, reduce the tacrolimus dose in advance and monitor trough levels and renal function frequently. Readjust the dose when ketoconazole 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 Ketoconazole
- Alfuzosin + Ketoconazole Contraindicated
- Alprazolam + Ketoconazole Contraindicated
- Avanafil + Ketoconazole Contraindicated
- Conivaptan + Ketoconazole Contraindicated
- Dihydroergotamine intranasal + Ketoconazole Contraindicated
- Dihydroergotamine + Ketoconazole 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 Ketoconazole with Tacrolimus?
MediHelp rates the interaction as major. Ketoconazole 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. Ketoconazole substantially increases tacrolimus blood concentrations, risking nephrotoxicity, neurotoxicity, hyperkalemia and QT prolongation. The effect can develop quickly and persist after ketoconazole is stopped.
How serious is the interaction between Ketoconazole 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: If coadministration is necessary, reduce the tacrolimus dose in advance and monitor trough levels and renal function frequently. Readjust the dose when ketoconazole is stopped.
What other medicines interact with Ketoconazole?
MediHelp also lists interactions of Ketoconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Ketoconazole page.
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