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Drug Interactions between Clotrimazole Troche and tacrolimus

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

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Interactions between your drugs

Major

clotrimazole tacrolimus

Applies to: Clotrimazole Troche (clotrimazole) and tacrolimus

MONITOR CLOSELY: Coadministration with clotrimazole may significantly increase the oral bioavailability of sirolimus and tacrolimus. The proposed mechanism is clotrimazole inhibition of sirolimus and tacrolimus metabolism via intestinal CYP450 3A4. In 17 post-transplant patients treated with clotrimazole troches (10 mg three times a day), significantly higher blood tacrolimus trough levels were observed by the third day compared to 18 patients treated with nystatin (5 mL four times a day). Levels were still higher in the clotrimazole group by day 7, although mean tacrolimus doses were significantly lower than in the nystatin group. The interaction has not been reported with sirolimus, although it should be expected based on its similar pharmacokinetic profile to tacrolimus.

MANAGEMENT: Caution is advised if sirolimus or tacrolimus is prescribed with clotrimazole. Immunosuppressant blood levels should be closely monitored and the dosage adjusted accordingly, particularly following initiation, discontinuation, or change of dosage of clotrimazole in patients who are stabilized on their antirejection regimen.

References

  1. (2001) "Product Information. Prograf (tacrolimus)." Fujisawa
  2. (2001) "Product Information. Rapamune (sirolimus)." Wyeth-Ayerst Laboratories
  3. Vasquez EM, Pollak R, Benedetti E (2001) "Clotrimazole increases tacrolimus blood levels: a drug interaction in kidney transplant patients." Clin Transplant, 15, p. 95-9

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Drug and food interactions

Moderate

tacrolimus food

Applies to: 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

  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

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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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