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Drug Interactions between Envarsus XR and Renagel

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

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Interactions between your drugs

Moderate

tacrolimus sevelamer

Applies to: Envarsus XR (tacrolimus) and Renagel (sevelamer)

MONITOR: Coadministration with sevelamer may reduce blood levels of oral cyclosporine, mycophenolate mofetil, and tacrolimus. The mechanism is reduction of absorption by sevelamer. Concomitant use of sevelamer with mycophenolate mofetil in adult and pediatric patients decreased the mean Cmax and AUC of mycophenolic acid (MPA) by 36% and 26%, respectively. Adverse effects, such as graft rejection in transplant patients, have not been reported. Data are lacking for an interaction with other phosphate binders.

MANAGEMENT: The immunosuppressant may be given at least 1 to 2 hours before or 2 to 3 hours after sevelamer administration to minimize the impact on absorption. It is recommended to closely monitor blood concentrations of the immunosuppressant during concomitant use and after discontinuation of sevelamer.

References

  1. (2001) "Product Information. CellCept (mycophenolate mofetil)." Roche Laboratories
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. EMEA. European Medicines Agency (2007) EPARs. European Union Public Assessment Reports. http://www.ema.europa.eu/ema/index.jsp?curl=pages/includes/medicines/medicines_landingpage.jsp&mid
  4. Cerner Multum, Inc. "Australian Product Information."
View all 4 references

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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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Moderate

sevelamer food

Applies to: Renagel (sevelamer)

ADJUST DOSING INTERVAL: Sevelamer may decrease the oral bioavailability of concomitantly administered drugs. While clinical data are lacking for most drugs, the intestinal absorption of some may be impaired due to sevelamer's binding capabilities.

MANAGEMENT: As a precaution, drugs that can be adversely affected by alterations in blood levels should be administered 1 hour before or 3 hours after sevelamer.

References

  1. (2001) "Product Information. Renagel (sevelamer)." Genzyme Corporation
  2. (2002) "Product Information. Xatral (alfuzosin)." Sanofi-Synthelabo Canada Inc

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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

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