Drug interactions
Lopinavir + Tacrolimus
Severity: Major
Lopinavir 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
Ritonavir-boosted lopinavir strongly inhibits CYP3A4 and can raise tacrolimus concentrations severalfold, leading to toxicity. Both drugs can also prolong the QT interval.
What this interaction means in plain words
Lopinavir 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.
Lopinavir belongs to Anti Virals; Tacrolimus belongs to Miscellaneous.
Why it happens
CYP3A4 and P-gp inhibition by the lopinavir/ritonavir combination, plus additive QT prolongation.
What to do
Use a markedly reduced tacrolimus dose with extended intervals, guided by frequent trough monitoring. Monitor renal function and ECG, and consider an alternative antiretroviral.
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 Lopinavir
- Alfuzosin + Lopinavir Contraindicated
- Avanafil + Lopinavir Contraindicated
- Cisapride + Lopinavir Contraindicated
- Dronedarone + Lopinavir Contraindicated
- Eletriptan + Lopinavir Contraindicated
- Eplerenone + Lopinavir Contraindicated
Frequently asked questions
Can I take Lopinavir with Tacrolimus?
MediHelp rates the interaction as major. Lopinavir 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. Ritonavir-boosted lopinavir strongly inhibits CYP3A4 and can raise tacrolimus concentrations severalfold, leading to toxicity. Both drugs can also prolong the QT interval.
How serious is the interaction between Lopinavir 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: Use a markedly reduced tacrolimus dose with extended intervals, guided by frequent trough monitoring. Monitor renal function and ECG, and consider an alternative antiretroviral.
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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