Drug Interaction Report

MONITOR: The concurrent or sequential use of two or more potentially nephrotoxic or neurotoxic drugs may increase the risk of toxicity. Patients who are elderly, debilitated, dehydrated, or who have preexisting renal dysfunction may have a higher risk of developing adverse reactions.

MANAGEMENT: Close clinical and laboratory monitoring of renal and neurologic function and drug serum concentrations (if clinically appropriate) is recommended.

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.