Major
Posaconazole × tacrolimus
Second-generation systemic triazole antifungal×Calcineurin inhibitor (immunosuppressant)
Mechanism
Posaconazole is a strong CYP3A4 inhibitor. Tacrolimus rises 4-5 fold.
Symptoms
Nephrotoxicity, tremor.
Management
Reduce tacrolimus by 67%, check blood level on days 3-5.
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
- EMA: Noxafil (posaconazole) Summary of Product Characteristics (2024)– EMA EPAR Noxafil