Prednisone with Tacrolimus Interaction Details

Brand Names Associated with Prednisone

Brand Names Associated with Tacrolimus

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 05, 2023

Interaction Effect

Decreased tacrolimus trough concentrations and increased risk of organ rejection

Interaction Summary

Concomitant use of tacrolimus (a CYP3A substrate) with a weak or moderate CYP3A inducer may increase the metabolism of tacrolimus, leading to lower whole blood trough concentrations and a greater risk of rejection. In a study, tacrolimus coadministered with nafcillin (a moderate CYP3A inducer) resulted in undetectable tacrolimus levels on hospital day 8 . If tacrolimus is used concomitantly with a weak or moderate CYP3A inducer, monitor tacrolimus blood levels, adjust the tacrolimus dose as needed, and monitor for reduced tacrolimus efficacy .

Severity

Major

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

Concomitant use of tacrolimus with a weak or moderate CYP3A inducer may increase the metabolism of tacrolimus, leading to lower whole blood trough concentrations and a greater risk of rejection. If coadministered, monitor tacrolimus blood levels, adjust tacrolimus dose as needed, and monitor for reduced tacrolimus efficacy.

Mechanism Of Interaction

Induction of CYP3A-mediated tacrolimus metabolism

Literature Reports

A) A 13-year-old boy with a past medical history significant for cystic fibrosis, liver disease requiring transplantation, type 1 diabetes, and pancreatic insufficiency experienced subtherapeutic levels of tacrolimus (a CYP3A substrate) following therapy with nafcillin (a moderate CYP3A inducer) for a suspected infection. The patient's tacrolimus dose was 1.5 mg orally twice daily with a goal trough of 3 to 5 nanograms/milliliter (ng/mL). Tacrolimus concentration was 2.8 ng/mL 1 week prior to admission; levels were 4.2 ng/mL following 2 doses of nafcillin 2 g, 2 ng/mL following 10 doses of nafcillin, and undetectable (less than 2 ng/mL) on hospital day 8. Tacrolimus levels returned to therapeutic range 5 days after nafcillin discontinuation and remained therapeutic at 2-month follow-up. Similar results were reported when nafcillin was readministered several months later .

Prednisone Overview

• Prednisone is used alone or with other medications to treat the symptoms of low corticosteroid levels (lack of certain substances that are usually produced by the body and are needed for normal body functioning). Prednisone is also used to treat other conditions in patients with normal corticosteroid levels. These conditions include certain types of arthritis; severe allergic reactions; multiple sclerosis (a disease in which the nerves do not function properly); lupus (a disease in which the body attacks many of its own organs); and certain conditions that affect the lungs, skin, eyes, kidneys blood, thyroid, stomach, and intestines. Prednisone is also sometimes used to treat the symptoms of certain types of cancer. Prednisone is in a class of medications called corticosteroids. It works to treat patients with low levels of corticosteroids by replacing steroids that are normally produced naturally by the body. It works to treat other conditions by reducing swelling and redness and by changing the way the immune system works.

Tacrolimus Overview

• 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:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.