Drug interactions
Tacrolimus + Tolmetin
Severity: Major
Tacrolimus and Tolmetin: 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
Tolmetin and tacrolimus can each impair kidney function, and using them together raises the chance of acute kidney injury and a rise in serum creatinine. Hyperkalemia may also occur. The risk is greatest with dehydration, existing renal impairment or high tacrolimus levels.
What this interaction means in plain words
Tacrolimus and Tolmetin 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.
Tacrolimus belongs to Miscellaneous; Tolmetin belongs to Musculoskeletal.
Why it happens
NSAID inhibition of renal prostaglandins reduces afferent arteriolar flow, adding to tacrolimus-induced renal vasoconstriction.
What to do
Avoid the NSAID where possible and use a non-NSAID analgesic such as paracetamol. If it is unavoidable, use the lowest dose for the shortest time and monitor serum creatinine, potassium and tacrolimus trough levels.
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 Tolmetin
- Ketorolac intranasal + Tolmetin Contraindicated
- Ketorolac + Tolmetin Contraindicated
- Aceclofenac + Tolmetin Major
- Acemetacin + Tolmetin Major
- Alteplase + Tolmetin Major
- Amlodipine-hydrochlorothiazide-valsartan + Tolmetin Major
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 Tacrolimus with Tolmetin?
MediHelp rates the interaction as major. Tacrolimus and Tolmetin 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. Tolmetin and tacrolimus can each impair kidney function, and using them together raises the chance of acute kidney injury and a rise in serum creatinine. Hyperkalemia may also occur. The risk is greatest with dehydration, existing renal impairment or high tacrolimus levels.
How serious is the interaction between Tacrolimus and Tolmetin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the NSAID where possible and use a non-NSAID analgesic such as paracetamol. If it is unavoidable, use the lowest dose for the shortest time and monitor serum creatinine, potassium and tacrolimus trough levels.
What other medicines interact with Tolmetin?
MediHelp also lists interactions of Tolmetin with, for example, Ketorolac intranasal, Ketorolac, Aceclofenac. The full list is on the Tolmetin page.
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