MACROLIDES AND TACROLIMUS
Several patients have had marked increases in serum tacrolimus levels accompanied by evidence of renal toxicity when they also took erythromycin. The same interaction has been seen in patients given clarithromycin, and is predicted with josamycin.
Tacrolimus levels and/or effects (e.g. on renal function) should be monitored as a
matter of routine, but it may be prudent to increase monitoring if these macrolides are started or stopped. Note that the macrolides differ in their ability to inhibit
CYP3A4, see macrolides. Azithromycin has been predicted not to interact and in general case reports seem to confirm this, although one patient has experienced increased tacrolimus levels when also taking azithromycin.
Tacrolimus levels and/or effects (e.g. on renal function) should be monitored as a
matter of routine, but it may be prudent to increase monitoring if these macrolides are started or stopped. Note that the macrolides differ in their ability to inhibit
CYP3A4, see macrolides. Azithromycin has been predicted not to interact and in general case reports seem to confirm this, although one patient has experienced increased tacrolimus levels when also taking azithromycin.