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Drug Interactions between Envarsus XR and potassium bicarbonate / sodium bicarbonate

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

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Interactions between your drugs

Moderate

sodium bicarbonate tacrolimus

Applies to: potassium bicarbonate / sodium bicarbonate and Envarsus XR (tacrolimus)

ADJUST DOSING INTERVAL: Sodium bicarbonate has been reported to cause widely variable trough plasma levels and reduced blood concentrations of tacrolimus when given close to the time of administration of tacrolimus. No other details were available in the report. Based on in vitro data, the mechanism appears to involve a pH-mediated degradation of tacrolimus. A 75% loss of tacrolimus was observed within 24 hours when tacrolimus was incubated in simulated gastric fluid with sodium bicarbonate. Other antacids tested (aluminum-magnesium hydroxide, magnesium oxide, calcium carbonate) also led to loss of tacrolimus.

MANAGEMENT: Until more data are available, it may be prudent to separate the times of administration of tacrolimus and sodium bicarbonate by at least two hours.

References

  1. (2001) "Product Information. Prograf (tacrolimus)." Fujisawa
  2. Venkataramanan R, Swaminathan A, Prasad T, et al. (1995) "Clinical pharmacokinetics of tacrolimus." Clin Pharmacokinet, 29, p. 404-30

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Drug and food interactions

Moderate

tacrolimus food

Applies to: Envarsus XR (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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