Clarithromycin with Tacrolimus Interaction Details
Brand Names Associated with Clarithromycin
- Biaxin® Filmtab®
- Biaxin® Granules
- Biaxin® XL Filmtab
- Biaxin® XL Pac
- Clarithromycin
Brand Names Associated with Tacrolimus
- Astagraf XL®
- Envarsus XR®
- FK 506
- Prograf®
- Tacrolimus
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
Increased tacrolimus exposure and an increased risk of QT interval prolongation
Interaction Summary
Concomitant use of tacrolimus with a strong CYP3A inhibitor that also has additive effects on the QT interval may increase tacrolimus whole blood trough concentrations and the risk of serious toxicity, including enhanced QT-interval prolongation and neurotoxicity. If concomitant use is required, decrease the tacrolimus dose and adjust based on whole blood trough concentrations. A rapid, sharp rise in tacrolimus levels may occur early, despite an immediate reduction of tacrolimus dose. Monitor whole blood trough concentrations early and frequently; start within 1 to 3 days and continue as necessary. In addition, consider obtaining electrocardiograms and monitoring electrolytes (magnesium, potassium, calcium) periodically during treatment.
Severity
Major
Onset
Rapid
Evidence
Established
How To Manage Interaction
Concomitant use of tacrolimus with a strong CYP3A inhibitor that also has additive effects on the QT interval may increase tacrolimus whole blood trough concentrations and the risk of serious toxicity, including enhanced QT-interval prolongation and neurotoxicity. If concomitant use is required, decrease the tacrolimus dose and adjust based on whole blood trough concentrations. A rapid, sharp rise in tacrolimus levels may occur early, despite an immediate reduction of tacrolimus dose. Monitor whole blood trough concentrations early and frequently; start within 1 to 3 days and continue as necessary. In addition, consider obtaining electrocardiograms and monitoring electrolytes (magnesium, potassium, calcium) periodically during treatment.
Mechanism Of Interaction
Inhibition of CYP3A-mediated tacrolimus metabolism; additive QT interval prolongation
Literature Reports
A) In a drug interaction study in healthy volunteers (n=9), administration of telaprevir 750 mg every 8 hours for 13 days concurrently with a single dose of tacrolimus 0.5 mg on day 8 led to significant increases in tacrolimus Cmax and AUC. Tacrolimus 2 mg was given orally, followed by a 14-day washout period; after the washout period, telaprevir 750 mg every 8 hours was administered for 13 days and a single dose of tacrolimus 0.5 mg was given on day 8. The geometric least squares mean ratios (tacrolimus 0.5 mg with telaprevir to tacrolimus 2 mg alone) for dose-normalized Cmax and AUC on day 8 after tacrolimus administration were 9.35 and 70.3, respectively .
Clarithromycin Overview
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Clarithromycin is used to treat certain bacterial infections, such as pneumonia (a lung infection), bronchitis (infection of the tubes leading to the lungs), and infections of the ears, sinuses, skin, and throat. It also is used to treat and prevent disseminated Mycobacterium avium complex (MAC) infection [a type of lung infection that often affects people with human immunodeficiency virus (HIV)]. It is used in combination with other medications to eliminate H. pylori, a bacterium that causes ulcers. Clarithromycin is in a class of medications called macrolide antibiotics. It works by stopping the growth of bacteria.
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Antibiotics such as clarithromycin will not work for colds, flu, or other viral infections. Taking antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.
Tacrolimus Overview
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Tacrolimus (Astagraf XL, Envarsus XR, Prograf) is used along with other medications to prevent rejection (attack of a transplanted organ by the immune system of a person receiving the organ) in people who have received a kidney transplant. Tacrolimus (Prograf) is also used along with other medications to prevent rejection in people who have received a liver, lung, or heart transplant. Tacrolimus is in a class of medications called immunosupressants. It works by decreasing the activity of the immune system to prevent it from attacking the transplanted organ.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.