Drug interactions
Roxithromycin + Tacrolimus
Severity: Moderate
Roxithromycin and Tacrolimus: moderate 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
Roxithromycin may raise tacrolimus concentrations, although it is a weaker CYP3A4 inhibitor than erythromycin or clarithromycin. Elevated levels can cause nephrotoxicity, neurotoxicity and QT effects.
What this interaction means in plain words
Roxithromycin and Tacrolimus can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Roxithromycin belongs to Anti Bacterial; Tacrolimus belongs to Miscellaneous.
Why it happens
Inhibition of CYP3A4 and P-glycoprotein reduces tacrolimus clearance.
What to do
Monitor tacrolimus trough levels and renal function during and after the antibiotic course. Reduce the tacrolimus dose as needed.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 Roxithromycin
- Digoxin + Roxithromycin Major
- Argatroban + Roxithromycin Moderate
- Cyclosporin + Roxithromycin Moderate
- Ampicillin-sulbactam + Roxithromycin Minor
- Ampicillin + Roxithromycin Minor
- Balsalazide + Roxithromycin Minor
Frequently asked questions
Can I take Roxithromycin with Tacrolimus?
MediHelp rates the interaction as moderate. Roxithromycin and Tacrolimus can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Roxithromycin may raise tacrolimus concentrations, although it is a weaker CYP3A4 inhibitor than erythromycin or clarithromycin. Elevated levels can cause nephrotoxicity, neurotoxicity and QT effects.
How serious is the interaction between Roxithromycin and Tacrolimus?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor tacrolimus trough levels and renal function during and after the antibiotic course. Reduce the tacrolimus dose as needed.
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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