Drug interactions
Mitotane + Tacrolimus
Severity: Major
Mitotane 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
Mitotane is a potent enzyme inducer that can substantially lower tacrolimus concentrations. This risks subtherapeutic immunosuppression and graft rejection, and the effect may persist for weeks after mitotane is stopped.
What this interaction means in plain words
Mitotane 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.
Mitotane belongs to Oncology; Tacrolimus belongs to Miscellaneous.
Why it happens
Induction of CYP3A4 (and possibly P-gp) increases tacrolimus clearance.
What to do
Monitor tacrolimus troughs frequently and increase the dose as required. Reassess levels and reduce the dose after mitotane is discontinued because induction wanes slowly.
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
Other interactions of Mitotane
- Doravirine + Mitotane Contraindicated
- Fostemsavir + Mitotane Contraindicated
- Lorlatinib + Mitotane Contraindicated
- Abiraterone + Mitotane Major
- Apixaban + Mitotane Major
- Aprepitant + Mitotane Major
Frequently asked questions
Can I take Mitotane with Tacrolimus?
MediHelp rates the interaction as major. Mitotane 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. Mitotane is a potent enzyme inducer that can substantially lower tacrolimus concentrations. This risks subtherapeutic immunosuppression and graft rejection, and the effect may persist for weeks after mitotane is stopped.
How serious is the interaction between Mitotane 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 tacrolimus troughs frequently and increase the dose as required. Reassess levels and reduce the dose after mitotane is discontinued because induction wanes slowly.
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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