Major
Erythromycin × tacrolimus
Macrolide antibiotic×Calcineurin inhibitor (immunosuppressant)
Mechanism
Erythromycin inhibits CYP3A4. Tacrolimus rises 2-3 fold – nephrotoxicity, neurotoxicity.
Symptoms
Rising creatinine, tremor, headache.
Management
Reduce tacrolimus by 50%, check blood level on day 3. Alternative – azithromycin.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Sources
- AEMPS: Ficha tecnica de Prograf (tacrolimus) (2024)– AEMPS CIMA, 2024