Major
Ketoconazole × tacrolimus
Systemic antimycotics. Imidazole derivatives×Calcineurin inhibitor (immunosuppressant)
Mechanism
Strong CYP3A4 inhibitor – tacrolimus rises 4-5 fold.
Symptoms
Nephrotoxicity.
Management
Reduce tacrolimus by 75%.
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.