Ibuprofen × Tacrolimus

Ibuprofen reduces renal blood flow via PGE2 inhibition. Tacrolimus is nephrotoxic in its own right. Additive acute kidney injury risk in transplant patients.

Reduced urine output, rising creatinine and potassium, oedema. The risk is higher in older patients, in kidney disease, heart failure or liver dysfunction, and with diuretics or angiotensin-converting enzyme inhibitors.

Avoid using tacrolimus with drugs known to harm the kidneys; the list names non-steroidal anti-inflammatory drugs (NSAIDs) and ibuprofen specifically (tacrolimus SmPC). If ibuprofen cannot be avoided, monitor renal function and other adverse effects and adjust the tacrolimus dose if needed (tacrolimus SmPC); monitor renal function closely (ibuprofen SmPC). The US Food and Drug Administration (FDA) also advises monitoring renal function and tacrolimus blood concentrations when tacrolimus is used with nephrotoxic drugs (US tacrolimus label). NSAIDs are highly bound to plasma proteins, so check tacrolimus trough blood concentrations and adjust the dose if needed (tacrolimus SmPC). Use ibuprofen at the lowest dose for the shortest time; it is contraindicated in severe renal impairment (glomerular filtration rate below 30 mL/min) (ibuprofen SmPC).