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Drug Interactions between bosentan and Prograf

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

tacrolimus bosentan

Applies to: Prograf (tacrolimus) and bosentan

MONITOR: Coadministration with bosentan may decrease the plasma concentrations and therapeutic effects of sirolimus and tacrolimus. The proposed mechanism is increased clearance due to bosentan-mediated induction of CYP450 3A4, the isoenzyme responsible for the metabolic clearance of sirolimus and tacrolimus. In addition, concomitant use with sirolimus or tacrolimus may increase the plasma concentrations of bosentan. The mechanism for this interaction has not been delineated.

MANAGEMENT: Given the risk of therapeutic failure and organ rejection associated with inadequate immunosuppressant drug levels, caution is advised if bosentan is used concomitantly with sirolimus or tacrolimus. Sirolimus and tacrolimus blood levels should be checked frequently, and the dosage adjusted accordingly whenever bosentan is added to or withdrawn from therapy. In addition, patients should be monitored for adverse effects associated with bosentan, such as hepatotoxicity and decreases in hemoglobin and hematocrit.

References (4)
  1. (2001) "Product Information. Prograf (tacrolimus)." Fujisawa
  2. (2001) "Product Information. Rapamune (sirolimus)." Wyeth-Ayerst Laboratories
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  4. Cerner Multum, Inc. "Australian Product Information."

Drug and food interactions

Moderate

tacrolimus food

Applies to: Prograf (tacrolimus)

ADJUST DOSING INTERVAL: Consumption of food has led to a 27% decrease in the bioavailability of orally administered tacrolimus.

MANAGEMENT: Tacrolimus should be administered at least one hour before or two hours after meals.

GENERALLY AVOID: Grapefruit juice has been reported to increase tacrolimus trough concentrations. Data are limited, but inhibition of the CYP450 enzyme system appears to be involved.

MANAGEMENT: The clinician may want to recommend that the patient avoid ingesting large amounts of grapefruit juice while taking tacrolimus.

References (2)
  1. (2001) "Product Information. Prograf (tacrolimus)." Fujisawa
  2. Hooks MA (1994) "Tacrolimus, a new immunosuppressant--a review of the literature." Ann Pharmacother, 28, p. 501-11

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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