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Interacting Drugs

OBJECT DRUGS

Immunosuppressants:

PRECIPITANT DRUGS

Antimicrobials:


Comment:

These antimicrobial agents may inhibit the CYP3A4 metabolism of cyclosporine, sirolimus, and tacrolimus, thus increasing their effect and potential toxicity. Inhibition of P-glycoprotein (PGP) may also contribute to the interactions. Azithromycin does not inhibit CYP3A4, but appears to inhibit PGP; it may increase plasma concentrations of these immunosuppressants by this mechanism. Clotrimazole troches have been shown to elevate tacrolimus blood levels, and would also be expected to interact with cyclosporine and sirolimus.


Class 2: Use Only if Benefit Felt to Outweigh Risk