tacrolimus (Rx)

Heart Transplant

Prophylaxis of organ rejection in patients receiving allogeneic transplants; use with azathioprine or mycophenolate mofetil (MMF) recommended

IV: 0.01 mg/kg/day by continuous infusion initially  

PO (immediate-release): 0.075 mg/kg/day divided q12hr initially  

Administer initial dose no sooner than 6 hr after transplantation

Liver Transplant

Prophylaxis of organ rejection in patients receiving allogeneic transplants

IV: 0.03-0.05 mg/kg/day by continuous infusion initially  

PO (immediate-release), with corticosteroids only: 0.1-0.15 mg/kg/day divided q12hr initially  

Administer initial dose no sooner than 6 hr after transplantation

Kidney Transplant

Prograf

• Prophylaxis of organ rejection in patients receiving allogeneic kidney transplants; used concomitantly with azathioprine or MMF or interleukin (IL)-2 receptor antagonist (eg, basiliximab or daclizumab) and corticosteroids
• IV: 0.03-0.05 mg/kg/day IV by continuous infusion initially  
• PO (with azathioprine): 0.2 mg/kg/day divided q12hr initially  
• PO (with MMF/IL-2 receptor antagonist): 0.1 mg/kg/day divided q12hr initially

Astagraf XL

• Prophylaxis of organ rejection in patients receiving kidney transplants; used concomitantly with MMF and corticosteroids, with or without basiliximab induction

• With basiliximab induction

  • MMF, corticosteroids, and initial tacrolimus dose may be administered before or within 48 hr after completion of renal transplantation but may be delayed until renal function has recovered
  • 15 mg/kg PO once daily

• Without induction

  • When agent is used with MMF and corticosteroids, preoperative dose should be given as single dose within 12 hr before reperfusion; initial postoperative dose should be given ≥4 hr after preoperative dose and ≤12 hr after reperfusion
  • Preoperative: 0.1 mg/kg PO once daily
  • Postoperative: 0.2 mg/kg PO once daily
  • Postoperative oliguria: Initial postoperative dose should be administered ≥6 hr and ≤48 hr after transplantation but may be delayed until renal function shows evidence of recovery

Envarsus XR

• Conversion from immediate-release tacrolimus

  • Indicated for prophylaxis of organ rejection in kidney transplant patients converted from tacrolimus immediate-release formulations in combination with other immunosuppressants
  • Administer an Envarsus XR dose that is 80% of the total daily dose of the tacrolimus immediate-release product
  • Monitor whole blood tacrolimus levels and titrate to achieve target whole blood trough concentration ranges of 4-11 ng/mL

• De novo kidney transplant

  • Indication for prophylaxis of organ rejection in de novo kidney transplant patients in combination with other immunosuppressants
  • Initiate at 0.14 mg/kg/day
  • Monitor whole blood tacrolimus levels and titrate to achieve target whole blood trough concentration ranges of 6-11 ng/mL (month 1) and 4-11 ng/mL (>month 1)

Lung Transplant

Prograf

Prophylaxis of organ rejection in patients receiving lung transplants in combination with other immunosuppressants

IV: 0.01-0.03 mg/kg/day by continuous infusion initially  

PO (with azathioprine or MMF): 0.075 mg/kg/day divided q12hr initially  

Patients with cystic fibrosis may require higher doses owing to lower bioavailability

Dosage Modifications

CYP3A5*1 allele

• African-American patients, compared to Caucasian patients, may need to be titrated to higher dosages to attain comparable trough concentrations
• ~80% of the African-American patients are carriers of the active, wild type CYP3A5*1 allele, resulting in a higher rate of tacrolimus clearance because of rapid metabolism

Coadministration with CYP3A4 inducers or inhibitors

• Dosage adjustment of Envarsus XR may be necessary
• Monitor tacrolimus trough concentrations ≥2 times on separate days during first week after initiation of dosing and after any change in dosage, after a change in coadministration of CYP3A inducers and/or inhibitors

Renal impairment

• Use lower end of dosing range
• Monitor renal function and adjust dose according to whole blood concentrations and tolerability

Hepatic impairment

• Mild: No dosage adjustment required
• Moderate: Monitor whole blood concentrations and adjust dose accordingly
• Severe (mean Child-Pugh score >10): Mean clearance of tacrolimus was substantially lower compared with normal hepatic function; dosage reduction recommended; administer 80% of preconversion daily dose of immediate release dosage form when converting from tacrolimus immediate release to extended release

Dosing Considerations

Capsules and granules are not interchangeable or substitutable with other tacrolimus extended-release products; owing to the rate of absorption following administration an extended-release tacrolimus is not equivalent to immediate-release tacrolimus drug product

Under- or overexposure to tacrolimus may result in graft rejection or other serious adverse reactions

African-American patients may need to be titrated to higher dosages to attain comparable trough concentrations compared to Caucasian patients

Monitor serum potassium

Dosage adjusted according to clinical response and observed tacrolimus whole-blood trough concentrations

• Kidney transplant

  • Trough level, Prograf with azathioprine (months 1-3): 7-20 ng/mL
  • Trough level, Prograf with azathioprine (months 4-12): 5-15 ng/mL
  • Trough level, Prograf with MMF/IL-2 receptor antagonist (months 1-12): 4-11 ng/mL
  • Trough level, Astragraf XL with basiliximab induction (during month 1): 7-15 ng/mL
  • Trough level, Astragraf XL with basiliximab induction (months 2-6): 5-15 ng/mL
  • Trough level, Astragraf XL with basiliximab induction (months >6): 5-10 ng/mL
  • Trough level, Astragraf XL without induction (during month 1): 10-15 ng/mL
  • Trough level, Astragraf XL without induction (months 2-6): 5-15 ng/mL
  • Trough level, Astragraf XL without induction (months >6): 5-10 ng/mL
  • Trough level, Envarsus XR: 4-11 ng/mL

• Liver transplant

  • Trough level, Prograf with corticosteroids only (months 1-12): 5-20 ng/mL

• Heart transplant

  • Trough level, Prograf with azathioprine or MMF (months 1-3): 10-20 ng/mL
  • Trough level, Prograf with azathioprine or MMF (months ≥4): 5-15 ng/mL

• Lung transplant

  • Trough level, Prograf with azathioprine or MMR (months 1-3): 10-15 ng/mL
  • Trough level, Prograf with azathioprine or MMF (months ≥4): 8-12 ng/mL

Graft-Versus-Host Disease (Orphan)

Prophylaxis of GVHD

Orphan indication sponsor

• Fujisawa USA, Inc, 3 Parkway North Center, Deerfield, IL 60015

Pulmonary Arterial Hypertension (Orphan)

Orphan designation for treatment of pulmonary arterial hypertension

Sponsor

• Selten Pharma, Inc; 14435C Big Basin Way #246; Saratoga, CA 95070

Hemorrhagic Cystitis (Orphan)

Orphan designation for treatment of hemorrhagic cystitis

Sponsor

• Lipella Pharmaceuticals Inc; 400 N. Lexington Ave, LL105; Pittsburgh, Pennsylvania 15208

Liver Transplant

Prograf

Prophylaxis of organ rejection in patients receiving liver transplants without preexisting renal or hepatic impairment

Administer initial dose no sooner than 6 hr after transplantation

IV: 0.03-0.05 mg/kg/day by continuous infusion initially  

Oral

• Capsules: 0.15-0.2 mg/kg/day divided q12hr initially  
• Granules: 0.2 mg/kg/day divided in 2 doses, administered q12hr initially  

Heart Transplant

Prograf

Prophylaxis of organ rejection in patients receiving allogeneic transplants, in combination with other immunosuppression

Initial dose

Administer initial dose no sooner than 6 hr after transplantation

IV: 0.01 mg/kg/day by continuous infusion initially  

Oral capsules and granules: 0.3 mg/kg/day divided in 2 doses, administered q12hr initially  

Kidney Transplant

Prograf

Prophylaxis of organ rejection in patients receiving allogeneic transplants, in combination with other immunosuppression

Administer initial dose no sooner than 24 hr after transplantation

IV: 0.03-0.05 mg/kg/day by continuous infusion initially  

Oral capsules and granules: 0.3 mg/kg/day divided in 2 doses, administered q12hr initially  

Lung Transplant

Prograf

Prophylaxis of organ rejection in patients receiving lung transplants in combination with other immunosuppressants

IV: 0.01-0.03 mg/kg/day by continuous infusion initially  

Oral capsules or granules: 0.03 mg/kg/day divided q12hr initially  

Dosage Modifications

CYP3A5*1 allele

• African-American patients, compared to Caucasian patients, may need to be titrated to higher dosages to attain comparable trough concentrations ~80% of the African-American patients are carriers of the active, wild type CYP3A5*1 allele, resulting in a higher rate of tacrolimus clearance because of rapid metabolism

Renal impairment

• Consider using lower end of dosing range in patients who have received a liver or heart transplant and have pre-existing renal impairment; may require further dose reductions below the targeted range
• In kidney transplant patients with post-operative oliguria, administer initial dose no sooner than 6 hr and within 24 hr of transplantation, but may be delayed until renal function shows evidence of recovery

Hepatic impairment

• Mild: No dosage adjustment required
• Moderate: Monitor whole blood concentrations and adjust dose accordingly
• Severe (mean Child-Pugh score >10): Mean clearance of tacrolimus was substantially lower compared with normal hepatic function; dosage reduction recommended; administer 80% of preconversion daily dose of immediate release dosage form when converting from tacrolimus immediate release to extended release

Dosing Considerations

When converting between Prograf granules and Prograf capsules, the total daily dose should remain the same

Prograf capsules and granules are not interchangeable or substitutable with other tacrolimus extended-release products; owing to the rate of absorption following administration an extended-release tacrolimus is not equivalent to immediate-release tacrolimus drug product

Under- or overexposure to tacrolimus may result in graft rejection or other serious adverse reactions

Do not use without supervision of a physician with experience in immunosuppressive therapy

African-American patients may need to be titrated to higher dosages to attain comparable trough concentrations compared to Caucasian patients

IV formulation

• Intravenous use is recommended for patients who cannot tolerate oral formulations, and conversion from IV to PO tacrolimus is recommended as soon as oral therapy can be tolerated to minimize the risk of anaphylactic reactions that occurred with injectables containing castor oil derivatives
• Patients receiving the injection should be under continuous observation for at least the first 30 minutes following the start of the infusion and at frequent intervals thereafter
• If signs or symptoms of anaphylaxis occur, stop the infusion
• Aqueous epinephrine solution and a source of oxygen should be available at the bedside

Adjust oral dose according to clinical response and whole blood trough concentration

• Pediatric kidney, liver, or heart transplant recipients: Prograf trough level (months 1-12): 5-20 ng/mL

• Pediatric lung transplant recipients: Prograf trough level (weeks 1-2: 10-20 ng/mL)

• Pediatric lung transplant recipients: Prograf trough level (week 2 to month 12: 10-15 ng/mL)

• Lung transplant recipients with cystic fibrosis

  • May require higher doses to achieve target trough concentration owing to lower oral bioavailability
  • Monitor and adjust dose accordingly

Contraindicated (10)

• amphotericin B deoxycholate

  amphotericin B deoxycholate and tacrolimus both increase nephrotoxicity and/or ototoxicity. Contraindicated.

• cidofovir

  cidofovir and tacrolimus both increase nephrotoxicity and/or ototoxicity. Contraindicated.

• dronedarone

  tacrolimus and dronedarone both increase QTc interval. Contraindicated.

• elagolix

  tacrolimus will increase the level or effect of elagolix by Other (see comment). Contraindicated. Concomitant use of elagolix and strong OATP1B1 inhibitors is contraindicated.

• fluconazole

  tacrolimus and fluconazole both increase QTc interval. Contraindicated.

• lefamulin

  lefamulin will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

• mifepristone

  mifepristone increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated with CYP3A substrates that have a narrow therapeutic index .

• neomycin PO

  neomycin PO and tacrolimus both increase nephrotoxicity and/or ototoxicity. Contraindicated.

• saquinavir

  saquinavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  tacrolimus and saquinavir both increase QTc interval. Contraindicated.

• thioridazine

  tacrolimus and thioridazine both increase QTc interval. Contraindicated.

Serious - Use Alternative (225)

• adagrasib

  adagrasib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of adagrasib, a CYP3A4 inhibitor, with sensitive CYP3A substrates unless otherwise recommended in the prescribing information for these substrates.
  
  adagrasib, tacrolimus. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• adalimumab

  adalimumab and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• adenovirus types 4 and 7 live, oral

  tacrolimus decreases effects of adenovirus types 4 and 7 live, oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3mo after cessation of immunosuppressive therapy.

• afatinib

  tacrolimus increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.

• alefacept

  alefacept and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• alpelisib

  tacrolimus will increase the level or effect of alpelisib by Other (see comment). Avoid or Use Alternate Drug. Coadministration of alpelisib (BCRP substrate) with a BCRP inhibitor may increase alpelisib concentration, which may increase the risk of toxicities. If unable to avoid or use alternant drugs, closely monitor for increased adverse reactions.

• amikacin

  amikacin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

• amiodarone

  tacrolimus and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

• amisulpride

  amisulpride and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• anagrelide

  tacrolimus and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
  
  anagrelide and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• anakinra

  anakinra and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• anthrax vaccine

  tacrolimus decreases effects of anthrax vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• antithymocyte globulin equine

  antithymocyte globulin equine and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• antithymocyte globulin rabbit

  antithymocyte globulin rabbit and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• apalutamide

  apalutamide will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• arsenic trioxide

  tacrolimus and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

• artemether

  artemether and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  tacrolimus and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine

  tacrolimus and asenapine both increase QTc interval. Avoid or Use Alternate Drug.
  
  asenapine and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine transdermal

  asenapine transdermal and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• axicabtagene ciloleucel

  tacrolimus, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• azathioprine

  azathioprine and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• azithromycin

  tacrolimus and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.

• bacitracin

  tacrolimus and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs

• baricitinib

  baricitinib, tacrolimus. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Baricitinib is not recommended in combination with other JAK inhibitors, biologic DMARDs, or potent immunosuppressives.

• basiliximab

  basiliximab and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• BCG vaccine live

  tacrolimus decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• bosutinib

  tacrolimus increases levels of bosutinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• bremelanotide

  bremelanotide will decrease the level or effect of tacrolimus by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

• brexucabtagene autoleucel

  tacrolimus, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• brigatinib

  brigatinib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Brigatinib induces CYP3A4 in vitro. Coadministration with CYP3A4 substrates, particularly those with a narrow therapeutic index, can result in decreased concentrations and loss of efficacy. If unable to avoid coadministration, monitor CYP3A4 substrate levels and adjust dose as needed.

• buprenorphine

  tacrolimus and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  buprenorphine buccal and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  buprenorphine subdermal implant and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine transdermal

  buprenorphine transdermal and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  buprenorphine, long-acting injection and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• canakinumab

  canakinumab and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• carbamazepine

  carbamazepine will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Monitor tacrolimus levels and adjust dose accordingly

• ceritinib

  ceritinib increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concurrent use of CYP3A substrates known to have narrow therapeutic indices or substrates primarily metabolized by CYP3A during treatment with ceritinib; if use of these medications is unavoidable, consider dose.
  
  ceritinib and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• chloramphenicol

  chloramphenicol will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• chlorpromazine

  tacrolimus and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.

• ciltacabtagene autoleucel

  tacrolimus, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• cimetidine

  cimetidine will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• clarithromycin

  clarithromycin will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  clarithromycin and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• contrast media (iodinated)

  contrast media (iodinated) and tacrolimus both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

• crizotinib

  crizotinib increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of crizotinib with CYP3A substrates with narrow therapeutic indices should be avoided. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
  
  crizotinib and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• cyclosporine

  cyclosporine, tacrolimus. Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of tacrolimus with cyclosporine may increase the risk of nephrotoxicity and immunosuppressive effects. Additionally, both agents are CYP3A4 and P-gp substrates and may elevate serum levels of either agent when coadministered. Discontinue tacrolimus or cyclosporine therapy at least 24 hours before initiating therapy with the other agent.

• dabrafenib

  dabrafenib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  tacrolimus and dabrafenib both increase QTc interval. Avoid or Use Alternate Drug.

• desflurane

  desflurane and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• diclofenac

  diclofenac, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• diflunisal

  diflunisal, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• diphtheria & tetanus toxoids

  tacrolimus decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• diphtheria & tetanus toxoids/ acellular pertussis vaccine

  tacrolimus decreases effects of diphtheria & tetanus toxoids/ acellular pertussis vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine

  tacrolimus decreases effects of diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• disopyramide

  tacrolimus and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.

• dronedarone

  dronedarone will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. The use of dronedarone in combination with other medications that can prolong the QT interval is considered contraindicated.

• droperidol

  tacrolimus and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

• edoxaban

  tacrolimus will increase the level or effect of edoxaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Dose adjustment may be required with strong P-gp inhibitors. DVT/PE treatment: Decrease dose to 30 mg PO once daily. NVAF: No dose reduction recommended

• efavirenz

  efavirenz will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• eluxadoline

  tacrolimus increases levels of eluxadoline by decreasing metabolism. Avoid or Use Alternate Drug. Decrease eluxadoline dose to 75 mg PO BID if coadministered with OATP1B1 inhibitors. .

• encorafenib

  encorafenib and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• entrectinib

  entrectinib and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• enzalutamide

  enzalutamide will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• erdafitinib

  erdafitinib, tacrolimus. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with erdafitinib and sensitive CYP3A4 substrates with narrow therapeutic indices. Erdafitinib may altered plasma concentrations of CYP3A4 substrates, leading to either loss of activity or increased toxicity of the substrate.
  
  erdafitinib will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.

• eribulin

  eribulin and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin base

  erythromycin base will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  tacrolimus and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  erythromycin ethylsuccinate will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  tacrolimus and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  erythromycin lactobionate will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  tacrolimus and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  erythromycin stearate will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  tacrolimus and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

• etanercept

  etanercept and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• etodolac

  etodolac, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• fenoprofen

  fenoprofen, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• fexinidazole

  fexinidazole and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
  
  fexinidazole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• flecainide

  tacrolimus and flecainide both increase QTc interval. Avoid or Use Alternate Drug.

• flurbiprofen

  flurbiprofen, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• foscarnet

  tacrolimus and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.

• glasdegib

  tacrolimus and glasdegib both increase QTc interval. Avoid or Use Alternate Drug.

• glatiramer

  glatiramer and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• golimumab

  golimumab and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• hepatitis A vaccine inactivated

  tacrolimus decreases effects of hepatitis A vaccine inactivated by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• hepatitis a/b vaccine

  tacrolimus decreases effects of hepatitis a/b vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• hepatitis a/typhoid vaccine

  tacrolimus decreases effects of hepatitis a/typhoid vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• hepatitis b vaccine

  tacrolimus decreases effects of hepatitis b vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• human papillomavirus vaccine, nonavalent

  tacrolimus decreases effects of human papillomavirus vaccine, nonavalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.

• human papillomavirus vaccine, quadrivalent

  tacrolimus decreases effects of human papillomavirus vaccine, quadrivalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.

• hydroxychloroquine sulfate

  hydroxychloroquine sulfate and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
  
  hydroxychloroquine sulfate and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• ibuprofen

  ibuprofen, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• ibuprofen IV

  ibuprofen IV, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• ibutilide

  tacrolimus and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.

• idecabtagene vicleucel

  tacrolimus, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• idelalisib

  idelalisib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• ifosfamide

  ifosfamide, tacrolimus. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• iloperidone

  tacrolimus and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.

• indomethacin

  indomethacin, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• infliximab

  infliximab and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• influenza virus vaccine quadrivalent

  tacrolimus decreases effects of influenza virus vaccine quadrivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• influenza virus vaccine quadrivalent, adjuvanted

  tacrolimus decreases effects of influenza virus vaccine quadrivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

• influenza virus vaccine quadrivalent, cell-cultured

  tacrolimus decreases effects of influenza virus vaccine quadrivalent, cell-cultured by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• influenza virus vaccine quadrivalent, intranasal

  tacrolimus decreases effects of influenza virus vaccine quadrivalent, intranasal by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• influenza virus vaccine trivalent

  tacrolimus decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• influenza virus vaccine trivalent, adjuvanted

  tacrolimus decreases effects of influenza virus vaccine trivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

• inotuzumab

  tacrolimus and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.

• ioversol

  ioversol and tacrolimus both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

• isoflurane

  isoflurane and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• itraconazole

  itraconazole and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  ivosidenib and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
  
  ivosidenib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• Japanese encephalitis virus vaccine

  tacrolimus decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• ketoconazole

  ketoconazole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• ketoprofen

  ketoprofen, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• ketorolac

  ketorolac, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• lapatinib

  tacrolimus and lapatinib both increase QTc interval. Avoid or Use Alternate Drug.

• lasmiditan

  lasmiditan increases levels of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• lefamulin

  tacrolimus and lefamulin both increase QTc interval. Avoid or Use Alternate Drug.

• leflunomide

  leflunomide and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• lenvatinib

  tacrolimus and lenvatinib both increase QTc interval. Avoid or Use Alternate Drug.

• levoketoconazole

  levoketoconazole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• lisocabtagene maraleucel

  tacrolimus, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• lofexidine

  tacrolimus and lofexidine both increase QTc interval. Avoid or Use Alternate Drug.

• lonafarnib

  lonafarnib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

• lopinavir

  lopinavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  tacrolimus and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.

• lorlatinib

  lorlatinib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid use of lorlatinib with CYP3A substrates, where minimal concentration changes may lead to serious therapeutic failures of the substrate. If concomitant use is unavoidable, increase CYP3A substrate dosage in accordance with approved product labeling.

• lumacaftor/ivacaftor

  lumacaftor/ivacaftor will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Lumacaftor is a strong inducer of CYP3A. Avoid coadministration with sensitive CYP3A substrates or CYP3A substrates with a narrow therapeutic index.

• macimorelin

  macimorelin and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• measles (rubeola) vaccine

  tacrolimus decreases effects of measles (rubeola) vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• measles mumps and rubella vaccine, live

  tacrolimus decreases effects of measles mumps and rubella vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• measles, mumps, rubella and varicella vaccine, live

  tacrolimus decreases effects of measles, mumps, rubella and varicella vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• meclofenamate

  meclofenamate, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• mefenamic acid

  mefenamic acid, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• mefloquine

  mefloquine increases toxicity of tacrolimus by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• meloxicam

  meloxicam, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• melphalan

  melphalan, tacrolimus. Either decreases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects.

• meningococcal A C Y and W-135 polysaccharide vaccine combined

  tacrolimus decreases effects of meningococcal A C Y and W-135 polysaccharide vaccine combined by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• methadone

  tacrolimus and methadone both increase QTc interval. Avoid or Use Alternate Drug.

• midostaurin

  tacrolimus and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  mobocertinib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, increase CYP3A4 substrate dosage in accordance with its prescribing information.
  
  mobocertinib and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• moxifloxacin

  tacrolimus and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• muromonab CD3

  muromonab CD3 and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• mycophenolate

  mycophenolate and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• nabumetone

  nabumetone, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• naproxen

  naproxen, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• nefazodone

  nefazodone will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nilotinib

  tacrolimus and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

• nirmatrelvir

  nirmatrelvir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid, decrease tacrolimus dose by one-third. Strong CYP3A inhibitors may increase tacrolimus whole blood trough concentrations and increase risk of serious adverse reactions (eg, neurotoxicity, QT prolongation). A rapid, sharp rise in tacrolimus levels may occur early, despite an immediate reduction of tacrolimus dose.

• nirmatrelvir/ritonavir

  nirmatrelvir/ritonavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid, decrease tacrolimus dose by one-third. Strong CYP3A inhibitors may increase tacrolimus whole blood trough concentrations and increase risk of serious adverse reactions (eg, neurotoxicity, QT prolongation). A rapid, sharp rise in tacrolimus levels may occur early, despite an immediate reduction of tacrolimus dose.

• olutasidenib

  olutasidenib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of olutasidenib (a CYP3A4 inducer) with sensitive CYP3A substrates unless otherwise instructed in substrates prescribing information. If unavoidable, monitor for loss of therapeutic effect of sensitive CYP3A4 substrates.

• ondansetron

  ondansetron and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

• oxaliplatin

  oxaliplatin and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects.
  
  oxaliplatin and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• oxaprozin

  oxaprozin, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• pacritinib

  pacritinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• paliperidone

  tacrolimus and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.

• panobinostat

  tacrolimus and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.

• pasireotide

  tacrolimus and pasireotide both increase QTc interval. Avoid or Use Alternate Drug.

• pazopanib

  tacrolimus and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.

• pentamidine

  tacrolimus and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

• pexidartinib

  pexidartinib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of pexidartinib (a CYP3A4 inducer) with sensitive CYP3A substrates may lead to serious therapeutic failures. If concomitant use is unavoidable, increase the CYP3A substrate dosage in accordance with approved product labeling.

• pimavanserin

  tacrolimus and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.

• pimozide

  tacrolimus and pimozide both increase QTc interval. Contraindicated.

• piroxicam

  piroxicam, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• pitolisant

  tacrolimus and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• pneumococcal vaccine 13-valent

  tacrolimus decreases effects of pneumococcal vaccine 13-valent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• pneumococcal vaccine heptavalent

  tacrolimus decreases effects of pneumococcal vaccine heptavalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• pneumococcal vaccine polyvalent

  tacrolimus decreases effects of pneumococcal vaccine polyvalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• pomalidomide

  tacrolimus increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• ponesimod

  tacrolimus and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• posaconazole

  tacrolimus and posaconazole both increase QTc interval. Avoid or Use Alternate Drug.

• potassium phosphates, IV

  tacrolimus and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.

• procainamide

  tacrolimus and procainamide both increase QTc interval. Avoid or Use Alternate Drug.

• propafenone

  tacrolimus and propafenone both increase QTc interval. Avoid or Use Alternate Drug.

• protriptyline

  tacrolimus and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• quinidine

  quinidine will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
  
  tacrolimus and quinidine both increase QTc interval. Avoid or Use Alternate Drug.

• rabies vaccine

  tacrolimus decreases effects of rabies vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants may interfere with development of active immunity.

• rabies vaccine chick embryo cell derived

  tacrolimus decreases effects of rabies vaccine chick embryo cell derived by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• ranolazine

  tacrolimus and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.

• revefenacin

  tacrolimus increases levels of revefenacin by Other (see comment). Avoid or Use Alternate Drug. Comment: OATP1B1 and OATP1B3 transport inhibitors may increase systemic exposure of revefenacin's active metabolite. Coadministration not recommended.

• ribociclib

  ribociclib increases toxicity of tacrolimus by QTc interval. Avoid or Use Alternate Drug.

• rifabutin

  rifabutin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• rifampin

  rifampin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• rilonacept

  rilonacept and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• rimegepant

  tacrolimus will increase the level or effect of rimegepant by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• riociguat

  tacrolimus will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed

• romidepsin

  tacrolimus and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.

• ropeginterferon alfa 2b

  ropeginterferon alfa 2b, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.

• rotavirus oral vaccine, live

  tacrolimus decreases effects of rotavirus oral vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• rubella vaccine

  tacrolimus decreases effects of rubella vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• sevoflurane

  sevoflurane and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• siponimod

  siponimod and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• sirolimus

  sirolimus and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• smallpox (vaccinia) vaccine, live

  tacrolimus decreases effects of smallpox (vaccinia) vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• sotalol

  tacrolimus and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

• sotorasib

  sotorasib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the CYP3A4 substrate for dosage modifications
  
  sotorasib will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

• St John's Wort

  St John's Wort will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  St John's Wort decreases levels of tacrolimus by increasing metabolism. Avoid or Use Alternate Drug.

• sulbactam/durlobactam

  tacrolimus will increase the level or effect of sulbactam/durlobactam by Other (see comment). Avoid or Use Alternate Drug. Sulbactam is predicted to have active secretion by OATP1 as a significant portion of total clearance; therefore, inhibition of OAT1 may increase sulbactam plasma concentrations

• sulindac

  sulindac, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• teicoplanin

  tacrolimus and teicoplanin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

• telavancin

  tacrolimus and telavancin both increase QTc interval. Avoid or Use Alternate Drug.

• temsirolimus

  tacrolimus and temsirolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• tetanus toxoid adsorbed or fluid

  tacrolimus decreases effects of tetanus toxoid adsorbed or fluid by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• tetrabenazine

  tacrolimus and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

• tick-borne encephalitis vaccine

  tacrolimus decreases effects of tick-borne encephalitis vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• tipranavir

  tipranavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• tisagenlecleucel

  tacrolimus, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• tocilizumab

  tocilizumab and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• tofacitinib

  tacrolimus, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• tolmetin

  tolmetin, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• tongkat ali

  tacrolimus and tongkat ali both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• topotecan

  tacrolimus will increase the level or effect of topotecan by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Product labeling for PO topotecan recommends avoiding concomitant use of P-gp inhibitors; the interaction with IV topotecan may be less severe but is still likely of clinical significance

• toremifene

  tacrolimus and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

• travelers diarrhea and cholera vaccine inactivated

  tacrolimus decreases effects of travelers diarrhea and cholera vaccine inactivated by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• trazodone

  tacrolimus and trazodone both increase QTc interval. Avoid or Use Alternate Drug.

• tucatinib

  tucatinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

• typhoid polysaccharide vaccine

  tacrolimus decreases effects of typhoid polysaccharide vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• typhoid vaccine live

  tacrolimus decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• umeclidinium bromide/vilanterol inhaled

  tacrolimus increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• upadacitinib

  tacrolimus, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

• ustekinumab

  tacrolimus and ustekinumab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• vandetanib

  tacrolimus, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• varicella virus vaccine live

  tacrolimus decreases effects of varicella virus vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• vemurafenib

  tacrolimus and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.

• venetoclax

  tacrolimus will increase the level or effect of venetoclax by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If a P-gp inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.
  
  venetoclax will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. In vitro data suggest venetoclax may inhibit P-gp substrates at therapeutic dose levels in the gut. Avoid coadministration of narrow therapeutic index P-gp substrates with venetoclax. If a narrow therapeutic index P-gp substrate must be used, it should be taken at least 6 hr before venetoclax.

• vilanterol/fluticasone furoate inhaled

  tacrolimus increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• voriconazole

  tacrolimus and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.

• voxelotor

  voxelotor will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

• yellow fever vaccine

  tacrolimus decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• ziprasidone

  tacrolimus and ziprasidone both increase QTc interval. Contraindicated.

• zoster vaccine live

  tacrolimus decreases effects of zoster vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

Monitor Closely (344)

• acyclovir

  acyclovir and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• adefovir

  adefovir and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• albuterol

  albuterol and tacrolimus both increase QTc interval. Use Caution/Monitor.

• alfuzosin

  tacrolimus and alfuzosin both increase QTc interval. Use Caution/Monitor.
  
  alfuzosin and tacrolimus both increase QTc interval. Use Caution/Monitor.

• amikacin

  tacrolimus will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• amiodarone

  amiodarone will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• amitriptyline

  tacrolimus will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• amlodipine

  amlodipine will increase the level or effect of tacrolimus by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Adjust dose when appropriate.

• amobarbital

  amobarbital will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• apomorphine

  apomorphine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• aprepitant

  aprepitant will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• arformoterol

  arformoterol and tacrolimus both increase QTc interval. Use Caution/Monitor.

• aripiprazole

  aripiprazole and tacrolimus both increase QTc interval. Use Caution/Monitor.

• armodafinil

  armodafinil will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• artemether/lumefantrine

  artemether/lumefantrine will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• astragalus

  tacrolimus increases and astragalus decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• atazanavir

  atazanavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atogepant

  tacrolimus will increase the level or effect of atogepant by Other (see comment). Modify Therapy/Monitor Closely. Recommended dosage of atogepant (an OATP1B1 substrate) with concomitant use of OATP inhibitors is 10 mg or 30 mg qDay.

• atomoxetine

  atomoxetine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• atorvastatin

  atorvastatin will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  tacrolimus increases toxicity of atorvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• azithromycin

  azithromycin will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• bazedoxifene/conjugated estrogens

  tacrolimus will increase the level or effect of bazedoxifene/conjugated estrogens by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• bedaquiline

  tacrolimus and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belatacept

  belatacept and tacrolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

• berotralstat

  berotralstat will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.
  
  berotralstat will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor or titrate substrate dose when berotralstat is coadministered with narrow therapeutic index drugs that are CYP3A substrates.

• betrixaban

  tacrolimus increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

• blinatumomab

  blinatumomab increases levels of tacrolimus by decreasing metabolism. Modify Therapy/Monitor Closely. Treatment initiation causes transient release of cytokines that may suppress CYP450 enzymes; highest drug-drug interaction risk is during the first 9 days of the first cycle and the first 2 days of the 2nd cycle in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index.

• bosentan

  bosentan will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• bosutinib

  bosutinib increases levels of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• brodalumab

  brodalumab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, brodalumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of brodalumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• bromocriptine

  bromocriptine increases levels of tacrolimus by decreasing metabolism. Use Caution/Monitor.

• budesonide

  budesonide will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of budesonide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• butabarbital

  butabarbital will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• butalbital

  butalbital will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• canagliflozin

  tacrolimus and canagliflozin both increase serum potassium. Use Caution/Monitor.

• cannabidiol

  cannabidiol will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Therapeutic drug monitoring and dose reduction of P-gp substrates should be considered when given orally and concurrently with cannabidiol

• capreomycin

  capreomycin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• carboplatin

  carboplatin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• cenobamate

  cenobamate will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

• cephaloridine

  cephaloridine and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• ceritinib

  tacrolimus increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• chloroquine

  chloroquine increases toxicity of tacrolimus by QTc interval. Use Caution/Monitor.

• cholera vaccine

  tacrolimus decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

• ciprofloxacin

  tacrolimus and ciprofloxacin both increase QTc interval. Use Caution/Monitor.

• cisplatin

  cisplatin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• citalopram

  tacrolimus and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• clarithromycin

  clarithromycin will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• clomipramine

  tacrolimus and clomipramine both increase QTc interval. Use Caution/Monitor.

• clotrimazole

  clotrimazole will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• clozapine

  clozapine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• cobicistat

  cobicistat will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• colistin

  colistin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• conivaptan

  conivaptan will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• conjugated estrogens

  tacrolimus will increase the level or effect of conjugated estrogens by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• conjugated estrogens, vaginal

  tacrolimus will increase the level or effect of conjugated estrogens, vaginal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• cortisone

  cortisone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of cortisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• crizotinib

  crizotinib increases levels of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• crofelemer

  crofelemer increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

• dabigatran

  tacrolimus will increase the level or effect of dabigatran by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Atrial fibrillation: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <30 mL/min. DVT/PE treatment: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <50 mL/min

• darifenacin

  darifenacin will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• darunavir

  darunavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• dasatinib

  dasatinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  dasatinib and tacrolimus both increase QTc interval. Use Caution/Monitor.

• daunorubicin

  tacrolimus will increase the level or effect of daunorubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• deferasirox

  deferasirox will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of deferasirox with potentially nephrotoxic drugs, including tacrolimus, may increase the risk of this toxicity. Monitor serum creatinine and/or creatinine clearance in patients.

• deflazacort

  tacrolimus will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• degarelix

  degarelix and tacrolimus both increase QTc interval. Use Caution/Monitor.

• dengue vaccine

  tacrolimus decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

• denosumab

  tacrolimus, denosumab. Other (see comment). Use Caution/Monitor. Comment: Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

• desipramine

  desipramine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• deutetrabenazine

  deutetrabenazine and tacrolimus both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexamethasone

  dexamethasone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of dexamethasone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• dexlansoprazole

  dexlansoprazole will increase the level or effect of tacrolimus by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Dexlansoprazole and tacrolimus compete for CYP2C19 metabolism. Concomitant administration may increase tacrolimus whole blood concentrations, particularly in intermediate or poor metabolizers of CYP2C19

• DHEA, herbal

  DHEA, herbal will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dichlorphenamide

  dichlorphenamide and tacrolimus both decrease serum potassium. Use Caution/Monitor.
  
  dichlorphenamide, tacrolimus. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

• digoxin

  tacrolimus will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• diltiazem

  diltiazem will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• docetaxel

  tacrolimus will increase the level or effect of docetaxel by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• dofetilide

  dofetilide increases toxicity of tacrolimus by QTc interval. Use Caution/Monitor.

• dolasetron

  dolasetron and tacrolimus both increase QTc interval. Use Caution/Monitor.

• donepezil

  donepezil and tacrolimus both increase QTc interval. Use Caution/Monitor.

• doxepin

  doxepin and tacrolimus both increase QTc interval. Use Caution/Monitor.

• doxorubicin

  tacrolimus will increase the level or effect of doxorubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• doxorubicin liposomal

  tacrolimus will increase the level or effect of doxorubicin liposomal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• dronabinol

  dronabinol increases levels of tacrolimus by plasma protein binding competition. Modify Therapy/Monitor Closely. Dronabinol is highly bound to plasma proteins and may displace and increase the free fraction of other concomitantly administered highly protein-bound drugs. This has not been confirmed in vivo. Caution with narrow therapeutic index drugs that are highly protein bound when initiating or increasing the dose of dronabinol.

• dronedarone

  dronedarone will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dulaglutide

  dulaglutide, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Dulaglutide slows gastric emptying and may impact absorption of concomitantly administered oral medications; be particularly cautious when coadministered with drugs that have a narrow therapeutic index.

• dupilumab

  dupilumab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, dupilumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of dupilumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• duvelisib

  duvelisib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

• echinacea

  tacrolimus increases and echinacea decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• efavirenz

  efavirenz and tacrolimus both increase QTc interval. Use Caution/Monitor.

• elacestrant

  elacestrant will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Reduce dose of P-gp substrates per their Prescribing Information when minimal concentration changes may lead to serious or life-threatening adverse reactions.

• elagolix

  elagolix will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  elagolix decreases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• elbasvir/grazoprevir

  elbasvir/grazoprevir increases levels of tacrolimus by unknown mechanism. Modify Therapy/Monitor Closely. Frequently monitor tacrolimus whole blood concentrations, renal function, and tacrolimus-associated adverse events if coadministered with elbasvir/grazoprevir.

• eliglustat

  eliglustat increases levels of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.
  
  tacrolimus and eliglustat both increase QTc interval. Use Caution/Monitor.

• elranatamab

  elranatamab will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Elranatamab causes cytokine release syndrome (CRS) that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. This is more likely to occur from initiation of elranatamab step-up dosing up to 14 days after the first treatment dose and during and after CRS.

• eluxadoline

  eluxadoline increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution when CYP3A substrates that have a narrow therapeutic index are coadministered with eluxadoline.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
  
  tacrolimus and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• encorafenib

  encorafenib, tacrolimus. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

• epcoritamab

  epcoritamab, tacrolimus. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Epcoritamab causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. .

• erythromycin base

  erythromycin base will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• erythromycin ethylsuccinate

  erythromycin ethylsuccinate will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• erythromycin lactobionate

  erythromycin lactobionate will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• erythromycin stearate

  erythromycin stearate will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• escitalopram

  escitalopram increases toxicity of tacrolimus by QTc interval. Use Caution/Monitor.

• eslicarbazepine acetate

  eslicarbazepine acetate will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• esomeprazole

  esomeprazole will increase the level or effect of tacrolimus by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Concomitant administration may increase tacrolimus whole blood concentrations, particularly in intermediate or poor metabolizers of CYP2C19

• estradiol

  tacrolimus will increase the level or effect of estradiol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• estrogens conjugated synthetic

  tacrolimus will increase the level or effect of estrogens conjugated synthetic by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• estrogens esterified

  tacrolimus will increase the level or effect of estrogens esterified by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• estropipate

  tacrolimus will increase the level or effect of estropipate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ethinylestradiol

  ethinylestradiol will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• etoposide

  tacrolimus will increase the level or effect of etoposide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• etravirine

  etravirine will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• everolimus

  tacrolimus and everolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. If used for liver transplant immunosuppression (Zortress), reduce tacrolimus dose and use target serum concentration to reduce nephrotoxicity.

• ezogabine

  ezogabine, tacrolimus. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  fedratinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

• felodipine

  felodipine will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ferric maltol

  ferric maltol, tacrolimus. Either increases levels of the other by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Coadministration of ferric maltol with certain oral medications may decrease the bioavailability of either ferric maltol and some oral drugs. For oral drugs where reductions in bioavailability may cause clinically significant effects on its safety or efficacy, separate administration of ferric maltol from these drugs. Duration of separation may depend on the absorption of the medication concomitantly administered (eg, time to peak concentration, whether the drug is an immediate or extended release product).

• finerenone

  tacrolimus will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.
  
  tacrolimus and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.

• fingolimod

  tacrolimus increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .
  
  fingolimod and tacrolimus both increase QTc interval. Use Caution/Monitor.

• flibanserin

  tacrolimus will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

• fluconazole

  fluconazole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• fludrocortisone

  fludrocortisone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of fludrocortisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• fluoxetine

  tacrolimus and fluoxetine both increase QTc interval. Use Caution/Monitor.

• fluphenazine

  tacrolimus and fluphenazine both increase QTc interval. Use Caution/Monitor.

• fluvastatin

  tacrolimus increases toxicity of fluvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• fluvoxamine

  fluvoxamine will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus and fluvoxamine both increase QTc interval. Use Caution/Monitor.

• fosamprenavir

  fosamprenavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• fosaprepitant

  fosaprepitant will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• foscarnet

  foscarnet and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• fosphenytoin

  fosphenytoin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  fosphenytoin will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• fostamatinib

  fostamatinib will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.

• fostemsavir

  tacrolimus and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• gemifloxacin

  gemifloxacin and tacrolimus both increase QTc interval. Use Caution/Monitor.

• gemtuzumab

  tacrolimus and gemtuzumab both increase QTc interval. Use Caution/Monitor.

• gentamicin

  tacrolimus will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  gentamicin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• gilteritinib

  gilteritinib and tacrolimus both increase QTc interval. Use Caution/Monitor.

• glecaprevir/pibrentasvir

  tacrolimus will increase the level or effect of glecaprevir/pibrentasvir by decreasing metabolism. Use Caution/Monitor. Caution when coadministering glecaprevir/pibrentasvir with OATP1B1/OATP1B3 inhibitors
  
  glecaprevir/pibrentasvir will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• glofitamab

  glofitamab, tacrolimus. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Glofitamab causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. .

• glycerol phenylbutyrate

  glycerol phenylbutyrate will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Glycerol phenylbutyrate is a weak inducer of CYP3A4. Monitor for decreased efficacy of CYP3A4 substrates that have a narrow therapeutic index.

• goserelin

  tacrolimus and goserelin both increase QTc interval. Use Caution/Monitor.

• granisetron

  granisetron and tacrolimus both increase QTc interval. Use Caution/Monitor.

• grapefruit

  grapefruit will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• griseofulvin

  griseofulvin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• guselkumab

  guselkumab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of guselkumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• haemophilus influenzae type b vaccine

  tacrolimus decreases effects of haemophilus influenzae type b vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored. .

• haloperidol

  haloperidol and tacrolimus both increase QTc interval. Use Caution/Monitor.

• histrelin

  tacrolimus and histrelin both increase QTc interval. Use Caution/Monitor.

• hydrocortisone

  hydrocortisone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of hydrocortisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• hydroxyzine

  hydroxyzine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• ifosfamide

  ifosfamide, tacrolimus. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Ifosfamide may enhance the toxicities of myelosuppressive agents. Monitor for increased risk of myelosuppression.

• iloperidone

  iloperidone increases levels of tacrolimus by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

• imatinib

  tacrolimus will increase the level or effect of imatinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• imipramine

  tacrolimus and imipramine both increase QTc interval. Use Caution/Monitor.

• indacaterol, inhaled

  indacaterol, inhaled, tacrolimus. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• indinavir

  indinavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  indinavir will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• influenza virus vaccine quadrivalent, recombinant

  tacrolimus decreases effects of influenza virus vaccine quadrivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.

• influenza virus vaccine trivalent, recombinant

  tacrolimus decreases effects of influenza virus vaccine trivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.

• irinotecan

  tacrolimus will increase the level or effect of irinotecan by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• irinotecan liposomal

  tacrolimus will increase the level or effect of irinotecan liposomal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• isavuconazonium sulfate

  tacrolimus will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  isavuconazonium sulfate will increase the level or effect of tacrolimus by Other (see comment). Use Caution/Monitor. Isavuconazonium sulfate, an inhibitor of P-gp and CYP3A4, may increase the effects or levels of sensitive P-gp or CYP3A4 substrates, which may require dose adjustment.
  
  tacrolimus and isavuconazonium sulfate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor.

• isoniazid

  isoniazid will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• istradefylline

  istradefylline will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
  
  istradefylline will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

• ivacaftor

  ivacaftor increases levels of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.

• ivermectin

  tacrolimus will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ixekizumab

  ixekizumab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, ixekizumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of ixekizumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• ketoconazole

  ketoconazole will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• lansoprazole

  lansoprazole will increase the level or effect of tacrolimus by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Concomitant administration may increase tacrolimus whole blood concentrations, particularly in intermediate or poor metabolizers of CYP2C19

• lapatinib

  lapatinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  lapatinib will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• larotrectinib

  larotrectinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lenacapavir

  lenacapavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.

• letermovir

  tacrolimus increases levels of letermovir by decreasing metabolism. Use Caution/Monitor. Coadminstration of letermovir, an OATP1B1/3 substrate, with OATP1B1/3 inhibitors may increase letermovir plasma concentrations.
  
  letermovir increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor tacrolimus plasma concentrations during treatment and after discontinuation of letemovir and adjust dose of tacrolimus accordingly.

• leuprolide

  tacrolimus and leuprolide both increase QTc interval. Use Caution/Monitor.

• levamlodipine

  levamlodipine will increase the level or effect of tacrolimus by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when coadministered. Frequent monitoring of trough blood levels of cyclosporine and tacrolimus is recommended and adjust the dose when appropriate.

• levofloxacin

  tacrolimus and levofloxacin both increase QTc interval. Use Caution/Monitor.

• levoketoconazole

  levoketoconazole will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• lithium

  lithium and tacrolimus both increase QTc interval. Use Caution/Monitor.

• lomitapide

  lomitapide increases levels of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing dose when used concomitantly with lomitapide.

• lomustine

  lomustine and tacrolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects.

• lonafarnib

  lonafarnib will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.

• lonapegsomatropin

  lonapegsomatropin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• loperamide

  tacrolimus will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  tacrolimus and loperamide both increase QTc interval. Use Caution/Monitor.

• loratadine

  loratadine will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• lovastatin

  lovastatin will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• lumefantrine

  lumefantrine will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• maitake

  tacrolimus increases and maitake decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• maprotiline

  tacrolimus and maprotiline both increase QTc interval. Use Caution/Monitor.

• maraviroc

  tacrolimus will increase the level or effect of maraviroc by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• marijuana

  marijuana will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• meningococcal group B vaccine

  tacrolimus decreases effects of meningococcal group B vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Individuals with altered immunocompetence may have reduced immune responses to the vaccine.

• mercaptopurine

  mercaptopurine and tacrolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

• mestranol

  tacrolimus will increase the level or effect of mestranol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• metformin

  tacrolimus decreases effects of metformin by pharmacodynamic antagonism. Use Caution/Monitor.

• methotrexate

  methotrexate and tacrolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Combination may increase risk of myelosuppression.

• methoxyflurane

  methoxyflurane and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• methylprednisolone

  methylprednisolone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of methylprednisolone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• methyltestosterone

  methyltestosterone increases effects of tacrolimus by decreasing metabolism. Use Caution/Monitor.

• metoclopramide intranasal

  metoclopramide intranasal will increase the level or effect of tacrolimus by Other (see comment). Use Caution/Monitor. Metoclopramide may increase the absorption of tacrolimus. Monitor therapeutic drug concentrations and adjust the dose as needed.

• metronidazole

  metronidazole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• miconazole vaginal

  miconazole vaginal will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• mirtazapine

  mirtazapine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• mitotane

  mitotane decreases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• momelotinib

  tacrolimus increases toxicity of momelotinib by Other (see comment). Use Caution/Monitor. Comment: OATP1B1/B3 inhibitor increases momelotinib (OATP1B1/B3 subtrate) plasma concentrations, which may increase the risk of adverse reactions with momelotinib.

• nafcillin

  nafcillin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• naldemedine

  tacrolimus increases levels of naldemedine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with P-gp inhibitors.

• nefazodone

  nefazodone will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• nelfinavir

  nelfinavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of nelfinavir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• neomycin PO

  tacrolimus will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• nevirapine

  nevirapine will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nicardipine

  nicardipine will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  nicardipine increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nifedipine

  nifedipine will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  nifedipine will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• nilotinib

  nilotinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  nilotinib will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• nintedanib

  tacrolimus increases levels of nintedanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. If nintedanib adverse effects occur, management may require interruption, dose reduction, or discontinuation of therapy .

• nitazoxanide

  nitazoxanide, tacrolimus. Either increases levels of the other by Mechanism: plasma protein binding competition. Use Caution/Monitor.

• nortriptyline

  tacrolimus and nortriptyline both increase QTc interval. Use Caution/Monitor.

• ocrelizumab

  tacrolimus and ocrelizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration of ocrelizumab with immunosuppressants may increase the risk of immunosuppression.

• octreotide

  tacrolimus and octreotide both increase QTc interval. Use Caution/Monitor.

• ofatumumab SC

  ofatumumab SC, tacrolimus. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

• ofloxacin

  tacrolimus and ofloxacin both increase QTc interval. Use Caution/Monitor.

• olanzapine

  olanzapine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• olaparib

  tacrolimus and olaparib both increase pharmacodynamic synergism. Use Caution/Monitor. Coadministration with other other myelosuppressive anticancer agents, including DNA damaging agents, may potentiate and prolongate the myelosuppressive toxicity.

• olodaterol inhaled

  tacrolimus and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• omaveloxolone

  omaveloxolone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Omaveloxolone may reduce systemic exposure of sensitive CYP3A4 substrates. Check prescribing information of substrate if dosage modification is needed.

• ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)

  ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. When initiating therapy with Viekira Pak, the dose of tacrolimus needs to be reduced; do not administer tacrolimus on the day Viekira Pak is initiated; beginning the day after Viekira Pak is initiated, reinitiate tacrolimus at a reduced dose based on tacrolimus blood concentrations; typical tacrolimus dosing is 0.5 mg q7days; measure tacrolimus blood concentrations and adjust dose or dosing frequency to determine subsequent dose modifications; upon completion of Viekira Pak, the appropriate time to resume pre-Viekira Pak dose of tacrolimus should be guided by assessment of blood concentrations

• omeprazole

  omeprazole will increase the level or effect of tacrolimus by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Concomitant administration may increase tacrolimus whole blood concentrations, particularly in intermediate or poor metabolizers of CYP2C19

• oritavancin

  oritavancin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Oritavancin is a weak CYP3A4 inducer; caution if coadministered with CYP3A4 substrates that have a narrow therapeutic index

• osilodrostat

  osilodrostat and tacrolimus both increase QTc interval. Use Caution/Monitor.

• osimertinib

  osimertinib and tacrolimus both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• ospemifene

  tacrolimus, ospemifene. Either increases levels of the other by plasma protein binding competition. Modify Therapy/Monitor Closely.

• oxaliplatin

  oxaliplatin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• oxcarbazepine

  oxcarbazepine will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ozanimod

  ozanimod and tacrolimus both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.
  
  ozanimod, tacrolimus. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration with immunosuppressive therapies may increase the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs in order to avoid unintended additive immunosuppressive effects.

• paclitaxel

  tacrolimus will increase the level or effect of paclitaxel by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• paclitaxel protein bound

  tacrolimus will increase the level or effect of paclitaxel protein bound by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• palbociclib

  palbociclib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. The dose of sensitive CYP3A substrates with a narrow therapeutic index may need to be reduced if coadministered with palbociclib

• paliperidone

  tacrolimus will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• pantoprazole

  pantoprazole will increase the level or effect of tacrolimus by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Concomitant administration may increase tacrolimus whole blood concentrations, particularly in intermediate or poor metabolizers of CYP2C19

• paromomycin

  tacrolimus will increase the level or effect of paromomycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  paromomycin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• pentamidine

  pentamidine and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• pentobarbital

  pentobarbital will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• peramivir

  tacrolimus increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

• perphenazine

  tacrolimus and perphenazine both increase QTc interval. Use Caution/Monitor.

• phenobarbital

  phenobarbital will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  phenobarbital will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• phenytoin

  phenytoin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  phenytoin will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Tacrolimus dosage requirements may be greater when administered concurrently with phenytoin.

• pirtobrutinib

  pirtobrutinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Pirtobrutinib (a CYP3A4 inhibitor) may increase plasma concentrations of sensitive CYP3A4 substrate which may increase the risk of adverse reactions related to these substrates.

• pitavastatin

  tacrolimus increases toxicity of pitavastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• pitolisant

  pitolisant will decrease the level or effect of tacrolimus by Other (see comment). Use Caution/Monitor. Pitolisant is a borderline/weak inducer of CYP3A4. Monitor sensitive CYP3A4 substrates for reduced effectiveness if coadministered.

• poliovirus vaccine inactivated

  tacrolimus decreases effects of poliovirus vaccine inactivated by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored. .

• polymyxin B

  polymyxin B and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• ponatinib

  ponatinib increases levels of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ponesimod

  ponesimod and tacrolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• posaconazole

  posaconazole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of posaconazole by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• potassium citrate

  tacrolimus and potassium citrate both increase serum potassium. Use Caution/Monitor.

• potassium citrate/citric acid

  tacrolimus and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.

• pravastatin

  tacrolimus increases toxicity of pravastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• prednisolone

  tacrolimus will increase the level or effect of prednisolone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• prednisone

  prednisone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of prednisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• primaquine

  primaquine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• primidone

  primidone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• prochlorperazine

  tacrolimus and prochlorperazine both decrease QTc interval. Use Caution/Monitor.

• promethazine

  tacrolimus and promethazine both decrease QTc interval. Use Caution/Monitor.

• quercetin

  quercetin will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• quetiapine

  quetiapine, tacrolimus. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinine

  tacrolimus and quinine both increase QTc interval. Use Caution/Monitor.

• quinupristin/dalfopristin

  quinupristin/dalfopristin will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• quizartinib

  quizartinib, tacrolimus. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

• rabeprazole

  rabeprazole will increase the level or effect of tacrolimus by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Concomitant administration may increase tacrolimus whole blood concentrations, particularly in intermediate or poor metabolizers of CYP2C19
  
  rabeprazole, tacrolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Contomitant use of agents that can cause magnesium loss can result in hypomagnesemia.

• ranolazine

  ranolazine will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ribociclib

  ribociclib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Caution if ribociclib is coadministered with sensitive CYP3A4 substrates that have a narrow therapeutic index. Dose reduction for sensitive CYP3A4 substrates may be needed.

• rifampin

  rifampin will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• rifapentine

  rifapentine will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifaximin

  tacrolimus increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• rilpivirine

  rilpivirine increases toxicity of tacrolimus by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

• risperidone

  tacrolimus will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  tacrolimus and risperidone both increase QTc interval. Use Caution/Monitor.

• ritlecitinib

  ritlecitinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Ritlecitinib inhibits CYP3A4 substrates; coadministration increases AUC and peak plasma concentration sensitive substrates, which may increase risk of adverse reactions. Additional monitoring and dosage adjustment may be needed in accordance with product labeling of CYP3A substrates.

• ritonavir

  ritonavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  ritonavir will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• romidepsin

  tacrolimus will increase the level or effect of romidepsin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• roxithromycin

  roxithromycin increases levels of tacrolimus by decreasing metabolism. Use Caution/Monitor.

• rucaparib

  rucaparib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

• rufinamide

  rufinamide will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• sacubitril/valsartan

  tacrolimus will increase the level or effect of sacubitril/valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• saquinavir

  tacrolimus will increase the level or effect of saquinavir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• sarecycline

  sarecycline will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

• sarilumab

  sarilumab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of cytokines such as IL-6. Elevated IL-6 concentration may down-regulate CYP activity, such as in patients with RA, and, hence, increase drug levels compared with subjects without RA. Blockade of IL-6 signaling by IL-6 antagonists (eg, sarilumab) might reverse the inhibitory effect of IL-6 and restore CYP activity, leading to decreased drug concentrations. Caution when initiating or discontinuing sarilumab if coadministered with CYP450 substrates, especially those with a narrow therapeutic index.

• schisandra

  schisandra will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• secobarbital

  secobarbital will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• secukinumab

  secukinumab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• selpercatinib

  selpercatinib increases toxicity of tacrolimus by QTc interval. Use Caution/Monitor.

• sertraline

  sertraline and tacrolimus both increase QTc interval. Use Caution/Monitor.

• silodosin

  tacrolimus will increase the level or effect of silodosin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• siltuximab

  siltuximab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

• simvastatin

  simvastatin will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  tacrolimus increases toxicity of simvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• siponimod

  siponimod and tacrolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

• sipuleucel-T

  tacrolimus decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

• sirolimus

  sirolimus will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• solifenacin

  solifenacin and tacrolimus both increase QTc interval. Use Caution/Monitor.
  
  tacrolimus and solifenacin both increase QTc interval. Use Caution/Monitor.

• somapacitan

  somapacitan will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• somatrogon

  somatrogon will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• somatropin

  somatropin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• sorafenib

  sorafenib and tacrolimus both increase QTc interval. Use Caution/Monitor.

• spironolactone

  spironolactone will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. tacrolimus dose may need to be adjusted

• St John's Wort

  St John's Wort will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• stiripentol

  stiripentol, tacrolimus. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
  
  stiripentol will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

• streptomycin

  tacrolimus will increase the level or effect of streptomycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  streptomycin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• streptozocin

  streptozocin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• sunitinib

  sunitinib and tacrolimus both increase QTc interval. Use Caution/Monitor.
  
  tacrolimus and sunitinib both increase QTc interval. Use Caution/Monitor.

• talquetamab

  talquetamab will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Talquetamab causes cytokine release syndrome (CRS) that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. This is more likely to occur from initiation of talquetamab step-up dosing up to 14 days after the first treatment dose and during and after CRS.

• tazemetostat

  tazemetostat will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• teclistamab

  teclistamab will increase the level or effect of tacrolimus by altering metabolism. Use Caution/Monitor. Teclistamab causes release of cytokines that may suppress activity of CYP450 enzymes, resulting in increased exposure of CYP substrates. Monitor for increased concentrations or toxicities of sensitive CYP substrates. Adjust dose of CYP substrate drug as needed.

• tecovirimat

  tecovirimat will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• teduglutide

  teduglutide increases levels of tacrolimus by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.

• telotristat ethyl

  telotristat ethyl will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Telotristat ethyl induces CYP3A4 and may reduce systemic exposure of sensitive CYP3A4 substrates. Monitor for suboptimal efficacy and consider increasing the dose of the CYP3A4 substrate.

• teniposide

  tacrolimus will increase the level or effect of teniposide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• tenofovir DF

  tacrolimus and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• tinidazole

  tinidazole will increase the level or effect of tacrolimus by unknown mechanism. Use Caution/Monitor. Monitored for signs of calcineurin-inhibitor associated toxicities (eg, nephrotoxicity, cholestasis, paresthesias).
  
  tacrolimus will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tipranavir

  tipranavir, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Tacrolimus levels may incr or decr, due to contradictory effects of tipranavir on hepatic CYP3A4 and P glycoprotein.

• tobramycin

  tacrolimus will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  tacrolimus and tobramycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• tolvaptan

  tacrolimus will increase the level or effect of tolvaptan by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  tolvaptan will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• topiramate

  topiramate will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• trastuzumab

  trastuzumab, tacrolimus. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

• trastuzumab deruxtecan

  trastuzumab deruxtecan, tacrolimus. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

• trazodone

  trazodone will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• triclabendazole

  tacrolimus and triclabendazole both increase QTc interval. Use Caution/Monitor.

• trifluoperazine

  tacrolimus and trifluoperazine both decrease QTc interval. Use Caution/Monitor.

• trimipramine

  tacrolimus and trimipramine both increase QTc interval. Use Caution/Monitor.

• triptorelin

  tacrolimus and triptorelin both increase QTc interval. Use Caution/Monitor.

• trofinetide

  trofinetide will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor CYP3A4 substrates for which a small increase in plasma concentration may lead to serious toxicities if coadministered with trofinetide (a weak CYP3A4 inhibitor).

• tucatinib

  tucatinib will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

• turmeric

  turmeric will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ublituximab

  ublituximab and tacrolimus both increase immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Owing to potential additive immunosuppressive effects, consider duration of effect and mechanism of action of these therapies if coadministered

• ustekinumab

  ustekinumab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• valbenazine

  valbenazine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• vancomycin

  tacrolimus and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• vardenafil

  tacrolimus and vardenafil both increase QTc interval. Use Caution/Monitor.

• venlafaxine

  tacrolimus and venlafaxine both decrease QTc interval. Use Caution/Monitor.

• verapamil

  verapamil will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  verapamil will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• vinblastine

  tacrolimus will increase the level or effect of vinblastine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• vincristine

  tacrolimus will increase the level or effect of vincristine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• vincristine liposomal

  tacrolimus will increase the level or effect of vincristine liposomal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• voclosporin

  voclosporin and tacrolimus both increase serum potassium. Use Caution/Monitor.
  
  voclosporin, tacrolimus. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole

  voriconazole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• vorinostat

  tacrolimus and vorinostat both increase QTc interval. Use Caution/Monitor.
  
  vorinostat and tacrolimus both increase QTc interval. Use Caution/Monitor.

• zafirlukast

  zafirlukast will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• zoster vaccine recombinant

  tacrolimus decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.

Minor (41)

• acetazolamide

  acetazolamide will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• aliskiren

  tacrolimus will increase the level or effect of aliskiren by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• allopurinol

  allopurinol increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• alvimopan

  tacrolimus will increase the level or effect of alvimopan by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• amiodarone

  amiodarone increases levels of tacrolimus by decreasing renal clearance. Minor/Significance Unknown.

• anastrozole

  anastrozole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• armodafinil

  tacrolimus will increase the level or effect of armodafinil by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• budesonide

  budesonide, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• caspofungin

  caspofungin decreases levels of tacrolimus by unspecified interaction mechanism. Minor/Significance Unknown.

• chloroquine

  chloroquine increases levels of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• chlorpropamide

  chlorpropamide increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• clonidine

  clonidine increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• clotrimazole

  clotrimazole increases levels of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• cortisone

  cortisone, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• cyclophosphamide

  cyclophosphamide will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• danazol

  danazol increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• deflazacort

  deflazacort, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• dexamethasone

  dexamethasone, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• entecavir

  tacrolimus, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.

• fexofenadine

  tacrolimus will increase the level or effect of fexofenadine by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• fludrocortisone

  fludrocortisone, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• fluoxymesterone

  fluoxymesterone increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• food

  food decreases levels of tacrolimus by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• glimepiride

  glimepiride increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• glipizide

  glipizide increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• glyburide

  glyburide increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• hydrocortisone

  hydrocortisone, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• loratadine

  tacrolimus will increase the level or effect of loratadine by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• mesterolone

  mesterolone increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• methylprednisolone

  methylprednisolone, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• oxandrolone

  oxandrolone increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• oxymetholone

  oxymetholone increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• prednisolone

  prednisolone, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• prednisone

  prednisone, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• pyrazinamide

  pyrazinamide decreases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• testosterone

  testosterone increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• testosterone buccal system

  testosterone buccal system increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• testosterone topical

  testosterone topical increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• tolazamide

  tolazamide increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• tolbutamide

  tolbutamide increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• triamcinolone acetonide injectable suspension

  triamcinolone acetonide injectable suspension, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• acetazolamide

  Minor (1)acetazolamide will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• acyclovir

  Monitor Closely (1)acyclovir and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• adagrasib

  Serious - Use Alternative (2)adagrasib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of adagrasib, a CYP3A4 inhibitor, with sensitive CYP3A substrates unless otherwise recommended in the prescribing information for these substrates.
  
  adagrasib, tacrolimus. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• adalimumab

  Serious - Use Alternative (1)adalimumab and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• adefovir

  Monitor Closely (1)adefovir and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• adenovirus types 4 and 7 live, oral

  Serious - Use Alternative (1)tacrolimus decreases effects of adenovirus types 4 and 7 live, oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3mo after cessation of immunosuppressive therapy.

• afatinib

  Serious - Use Alternative (1)tacrolimus increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.

• albuterol

  Monitor Closely (1)albuterol and tacrolimus both increase QTc interval. Use Caution/Monitor.

• alefacept

  Serious - Use Alternative (1)alefacept and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• alfuzosin

  Monitor Closely (2)tacrolimus and alfuzosin both increase QTc interval. Use Caution/Monitor.
  
  alfuzosin and tacrolimus both increase QTc interval. Use Caution/Monitor.

• aliskiren

  Minor (1)tacrolimus will increase the level or effect of aliskiren by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• allopurinol

  Minor (1)allopurinol increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• alpelisib

  Serious - Use Alternative (1)tacrolimus will increase the level or effect of alpelisib by Other (see comment). Avoid or Use Alternate Drug. Coadministration of alpelisib (BCRP substrate) with a BCRP inhibitor may increase alpelisib concentration, which may increase the risk of toxicities. If unable to avoid or use alternant drugs, closely monitor for increased adverse reactions.

• alvimopan

  Minor (1)tacrolimus will increase the level or effect of alvimopan by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• amikacin

  Monitor Closely (1)tacrolimus will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)amikacin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

• amiodarone

  Monitor Closely (1)amiodarone will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)tacrolimus and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)amiodarone increases levels of tacrolimus by decreasing renal clearance. Minor/Significance Unknown.

• amisulpride

  Serious - Use Alternative (1)amisulpride and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• amitriptyline

  Monitor Closely (1)tacrolimus will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• amlodipine

  Monitor Closely (1)amlodipine will increase the level or effect of tacrolimus by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Adjust dose when appropriate.

• amobarbital

  Monitor Closely (1)amobarbital will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• amphotericin B deoxycholate

  Contraindicated (1)amphotericin B deoxycholate and tacrolimus both increase nephrotoxicity and/or ototoxicity. Contraindicated.

• anagrelide

  Serious - Use Alternative (2)tacrolimus and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
  
  anagrelide and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• anakinra

  Serious - Use Alternative (1)anakinra and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• anastrozole

  Minor (1)anastrozole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• anthrax vaccine

  Serious - Use Alternative (1)tacrolimus decreases effects of anthrax vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• antithymocyte globulin equine

  Serious - Use Alternative (1)antithymocyte globulin equine and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• antithymocyte globulin rabbit

  Serious - Use Alternative (1)antithymocyte globulin rabbit and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• apalutamide

  Serious - Use Alternative (1)apalutamide will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• apomorphine

  Monitor Closely (1)apomorphine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• aprepitant

  Monitor Closely (1)aprepitant will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• arformoterol

  Monitor Closely (1)arformoterol and tacrolimus both increase QTc interval. Use Caution/Monitor.

• aripiprazole

  Monitor Closely (1)aripiprazole and tacrolimus both increase QTc interval. Use Caution/Monitor.

• armodafinil

  Monitor Closely (1)armodafinil will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)tacrolimus will increase the level or effect of armodafinil by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• arsenic trioxide

  Serious - Use Alternative (1)tacrolimus and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

• artemether

  Serious - Use Alternative (1)artemether and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  Monitor Closely (1)artemether/lumefantrine will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)tacrolimus and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine

  Serious - Use Alternative (2)tacrolimus and asenapine both increase QTc interval. Avoid or Use Alternate Drug.
  
  asenapine and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine transdermal

  Serious - Use Alternative (1)asenapine transdermal and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• astragalus

  Monitor Closely (1)tacrolimus increases and astragalus decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• atazanavir

  Monitor Closely (1)atazanavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atogepant

  Monitor Closely (1)tacrolimus will increase the level or effect of atogepant by Other (see comment). Modify Therapy/Monitor Closely. Recommended dosage of atogepant (an OATP1B1 substrate) with concomitant use of OATP inhibitors is 10 mg or 30 mg qDay.

• atomoxetine

  Monitor Closely (1)atomoxetine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• atorvastatin

  Monitor Closely (2)atorvastatin will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  tacrolimus increases toxicity of atorvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• axicabtagene ciloleucel

  Serious - Use Alternative (1)tacrolimus, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• azathioprine

  Serious - Use Alternative (1)azathioprine and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• azithromycin

  Monitor Closely (1)azithromycin will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)tacrolimus and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.

• bacitracin

  Serious - Use Alternative (1)tacrolimus and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs

• baricitinib

  Serious - Use Alternative (1)baricitinib, tacrolimus. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Baricitinib is not recommended in combination with other JAK inhibitors, biologic DMARDs, or potent immunosuppressives.

• basiliximab

  Serious - Use Alternative (1)basiliximab and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• bazedoxifene/conjugated estrogens

  Monitor Closely (1)tacrolimus will increase the level or effect of bazedoxifene/conjugated estrogens by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• BCG vaccine live

  Serious - Use Alternative (1)tacrolimus decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• bedaquiline

  Monitor Closely (1)tacrolimus and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belatacept

  Monitor Closely (1)belatacept and tacrolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

• berotralstat

  Monitor Closely (2)berotralstat will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.
  
  berotralstat will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor or titrate substrate dose when berotralstat is coadministered with narrow therapeutic index drugs that are CYP3A substrates.

• betrixaban

  Monitor Closely (1)tacrolimus increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

• blinatumomab

  Monitor Closely (1)blinatumomab increases levels of tacrolimus by decreasing metabolism. Modify Therapy/Monitor Closely. Treatment initiation causes transient release of cytokines that may suppress CYP450 enzymes; highest drug-drug interaction risk is during the first 9 days of the first cycle and the first 2 days of the 2nd cycle in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index.

• bosentan

  Monitor Closely (1)bosentan will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• bosutinib

  Monitor Closely (1)bosutinib increases levels of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)tacrolimus increases levels of bosutinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• bremelanotide

  Serious - Use Alternative (1)bremelanotide will decrease the level or effect of tacrolimus by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

• brexucabtagene autoleucel

  Serious - Use Alternative (1)tacrolimus, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• brigatinib

  Serious - Use Alternative (1)brigatinib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Brigatinib induces CYP3A4 in vitro. Coadministration with CYP3A4 substrates, particularly those with a narrow therapeutic index, can result in decreased concentrations and loss of efficacy. If unable to avoid coadministration, monitor CYP3A4 substrate levels and adjust dose as needed.

• brodalumab

  Monitor Closely (1)brodalumab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, brodalumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of brodalumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• bromocriptine

  Monitor Closely (1)bromocriptine increases levels of tacrolimus by decreasing metabolism. Use Caution/Monitor.

• budesonide

  Monitor Closely (2)budesonide will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of budesonide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Minor (1)budesonide, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• buprenorphine

  Serious - Use Alternative (1)tacrolimus and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  Serious - Use Alternative (1)buprenorphine buccal and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  Serious - Use Alternative (1)buprenorphine subdermal implant and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine transdermal

  Serious - Use Alternative (1)buprenorphine transdermal and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  Serious - Use Alternative (1)buprenorphine, long-acting injection and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• butabarbital

  Monitor Closely (1)butabarbital will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• butalbital

  Monitor Closely (1)butalbital will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• canagliflozin

  Monitor Closely (1)tacrolimus and canagliflozin both increase serum potassium. Use Caution/Monitor.

• canakinumab

  Serious - Use Alternative (1)canakinumab and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• cannabidiol

  Monitor Closely (1)cannabidiol will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Therapeutic drug monitoring and dose reduction of P-gp substrates should be considered when given orally and concurrently with cannabidiol

• capreomycin

  Monitor Closely (1)capreomycin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• carbamazepine

  Serious - Use Alternative (1)carbamazepine will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Monitor tacrolimus levels and adjust dose accordingly

• carboplatin

  Monitor Closely (1)carboplatin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• caspofungin

  Minor (1)caspofungin decreases levels of tacrolimus by unspecified interaction mechanism. Minor/Significance Unknown.

• cenobamate

  Monitor Closely (1)cenobamate will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

• cephaloridine

  Monitor Closely (1)cephaloridine and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• ceritinib

  Monitor Closely (1)tacrolimus increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)ceritinib increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concurrent use of CYP3A substrates known to have narrow therapeutic indices or substrates primarily metabolized by CYP3A during treatment with ceritinib; if use of these medications is unavoidable, consider dose.
  
  ceritinib and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• chloramphenicol

  Serious - Use Alternative (1)chloramphenicol will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• chloroquine

  Monitor Closely (1)chloroquine increases toxicity of tacrolimus by QTc interval. Use Caution/Monitor.Minor (1)chloroquine increases levels of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• chlorpromazine

  Serious - Use Alternative (1)tacrolimus and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.

• chlorpropamide

  Minor (1)chlorpropamide increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• cholera vaccine

  Monitor Closely (1)tacrolimus decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

• cidofovir

  Contraindicated (1)cidofovir and tacrolimus both increase nephrotoxicity and/or ototoxicity. Contraindicated.

• ciltacabtagene autoleucel

  Serious - Use Alternative (1)tacrolimus, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• cimetidine

  Serious - Use Alternative (1)cimetidine will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• ciprofloxacin

  Monitor Closely (1)tacrolimus and ciprofloxacin both increase QTc interval. Use Caution/Monitor.

• cisplatin

  Monitor Closely (1)cisplatin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• citalopram

  Monitor Closely (1)tacrolimus and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• clarithromycin

  Monitor Closely (1)clarithromycin will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)clarithromycin will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  clarithromycin and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• clomipramine

  Monitor Closely (1)tacrolimus and clomipramine both increase QTc interval. Use Caution/Monitor.

• clonidine

  Minor (1)clonidine increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• clotrimazole

  Monitor Closely (1)clotrimazole will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Minor (1)clotrimazole increases levels of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• clozapine

  Monitor Closely (1)clozapine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• cobicistat

  Monitor Closely (1)cobicistat will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• colistin

  Monitor Closely (1)colistin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• conivaptan

  Monitor Closely (1)conivaptan will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• conjugated estrogens

  Monitor Closely (1)tacrolimus will increase the level or effect of conjugated estrogens by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• conjugated estrogens, vaginal

  Monitor Closely (1)tacrolimus will increase the level or effect of conjugated estrogens, vaginal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• contrast media (iodinated)

  Serious - Use Alternative (1)contrast media (iodinated) and tacrolimus both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

• cortisone

  Monitor Closely (2)cortisone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of cortisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Minor (1)cortisone, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• crizotinib

  Monitor Closely (1)crizotinib increases levels of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)crizotinib increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of crizotinib with CYP3A substrates with narrow therapeutic indices should be avoided. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
  
  crizotinib and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• crofelemer

  Monitor Closely (1)crofelemer increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

• cyclophosphamide

  Minor (1)cyclophosphamide will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cyclosporine

  Serious - Use Alternative (1)cyclosporine, tacrolimus. Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of tacrolimus with cyclosporine may increase the risk of nephrotoxicity and immunosuppressive effects. Additionally, both agents are CYP3A4 and P-gp substrates and may elevate serum levels of either agent when coadministered. Discontinue tacrolimus or cyclosporine therapy at least 24 hours before initiating therapy with the other agent.

• dabigatran

  Monitor Closely (1)tacrolimus will increase the level or effect of dabigatran by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Atrial fibrillation: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <30 mL/min. DVT/PE treatment: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <50 mL/min

• dabrafenib

  Serious - Use Alternative (2)dabrafenib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  tacrolimus and dabrafenib both increase QTc interval. Avoid or Use Alternate Drug.

• danazol

  Minor (1)danazol increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• darifenacin

  Monitor Closely (1)darifenacin will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• darunavir

  Monitor Closely (1)darunavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• dasatinib

  Monitor Closely (2)dasatinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  dasatinib and tacrolimus both increase QTc interval. Use Caution/Monitor.

• daunorubicin

  Monitor Closely (1)tacrolimus will increase the level or effect of daunorubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• deferasirox

  Monitor Closely (1)deferasirox will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of deferasirox with potentially nephrotoxic drugs, including tacrolimus, may increase the risk of this toxicity. Monitor serum creatinine and/or creatinine clearance in patients.

• deflazacort

  Monitor Closely (1)tacrolimus will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Minor (1)deflazacort, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• degarelix

  Monitor Closely (1)degarelix and tacrolimus both increase QTc interval. Use Caution/Monitor.

• dengue vaccine

  Monitor Closely (1)tacrolimus decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

• denosumab

  Monitor Closely (1)tacrolimus, denosumab. Other (see comment). Use Caution/Monitor. Comment: Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

• desflurane

  Serious - Use Alternative (1)desflurane and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• desipramine

  Monitor Closely (1)desipramine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• deutetrabenazine

  Monitor Closely (1)deutetrabenazine and tacrolimus both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexamethasone

  Monitor Closely (2)dexamethasone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of dexamethasone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Minor (1)dexamethasone, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• dexlansoprazole

  Monitor Closely (1)dexlansoprazole will increase the level or effect of tacrolimus by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Dexlansoprazole and tacrolimus compete for CYP2C19 metabolism. Concomitant administration may increase tacrolimus whole blood concentrations, particularly in intermediate or poor metabolizers of CYP2C19

• DHEA, herbal

  Monitor Closely (1)DHEA, herbal will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dichlorphenamide

  Monitor Closely (2)dichlorphenamide and tacrolimus both decrease serum potassium. Use Caution/Monitor.
  
  dichlorphenamide, tacrolimus. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

• diclofenac

  Serious - Use Alternative (1)diclofenac, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• diflunisal

  Serious - Use Alternative (1)diflunisal, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• digoxin

  Monitor Closely (1)tacrolimus will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• diltiazem

  Monitor Closely (1)diltiazem will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• diphtheria & tetanus toxoids

  Serious - Use Alternative (1)tacrolimus decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• diphtheria & tetanus toxoids/ acellular pertussis vaccine

  Serious - Use Alternative (1)tacrolimus decreases effects of diphtheria & tetanus toxoids/ acellular pertussis vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine

  Serious - Use Alternative (1)tacrolimus decreases effects of diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• disopyramide

  Serious - Use Alternative (1)tacrolimus and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.

• docetaxel

  Monitor Closely (1)tacrolimus will increase the level or effect of docetaxel by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• dofetilide

  Monitor Closely (1)dofetilide increases toxicity of tacrolimus by QTc interval. Use Caution/Monitor.

• dolasetron

  Monitor Closely (1)dolasetron and tacrolimus both increase QTc interval. Use Caution/Monitor.

• donepezil

  Monitor Closely (1)donepezil and tacrolimus both increase QTc interval. Use Caution/Monitor.

• doxepin

  Monitor Closely (1)doxepin and tacrolimus both increase QTc interval. Use Caution/Monitor.

• doxorubicin

  Monitor Closely (1)tacrolimus will increase the level or effect of doxorubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• doxorubicin liposomal

  Monitor Closely (1)tacrolimus will increase the level or effect of doxorubicin liposomal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• dronabinol

  Monitor Closely (1)dronabinol increases levels of tacrolimus by plasma protein binding competition. Modify Therapy/Monitor Closely. Dronabinol is highly bound to plasma proteins and may displace and increase the free fraction of other concomitantly administered highly protein-bound drugs. This has not been confirmed in vivo. Caution with narrow therapeutic index drugs that are highly protein bound when initiating or increasing the dose of dronabinol.

• dronedarone

  Contraindicated (1)tacrolimus and dronedarone both increase QTc interval. Contraindicated.Monitor Closely (1)dronedarone will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)dronedarone will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. The use of dronedarone in combination with other medications that can prolong the QT interval is considered contraindicated.

• droperidol

  Serious - Use Alternative (1)tacrolimus and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

• dulaglutide

  Monitor Closely (1)dulaglutide, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Dulaglutide slows gastric emptying and may impact absorption of concomitantly administered oral medications; be particularly cautious when coadministered with drugs that have a narrow therapeutic index.

• dupilumab

  Monitor Closely (1)dupilumab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, dupilumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of dupilumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• duvelisib

  Monitor Closely (1)duvelisib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

• echinacea

  Monitor Closely (1)tacrolimus increases and echinacea decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• edoxaban

  Serious - Use Alternative (1)tacrolimus will increase the level or effect of edoxaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Dose adjustment may be required with strong P-gp inhibitors. DVT/PE treatment: Decrease dose to 30 mg PO once daily. NVAF: No dose reduction recommended

• efavirenz

  Monitor Closely (1)efavirenz and tacrolimus both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)efavirenz will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• elacestrant

  Monitor Closely (1)elacestrant will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Reduce dose of P-gp substrates per their Prescribing Information when minimal concentration changes may lead to serious or life-threatening adverse reactions.

• elagolix

  Contraindicated (1)tacrolimus will increase the level or effect of elagolix by Other (see comment). Contraindicated. Concomitant use of elagolix and strong OATP1B1 inhibitors is contraindicated.Monitor Closely (2)elagolix will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  elagolix decreases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• elbasvir/grazoprevir

  Monitor Closely (1)elbasvir/grazoprevir increases levels of tacrolimus by unknown mechanism. Modify Therapy/Monitor Closely. Frequently monitor tacrolimus whole blood concentrations, renal function, and tacrolimus-associated adverse events if coadministered with elbasvir/grazoprevir.

• eliglustat

  Monitor Closely (2)tacrolimus and eliglustat both increase QTc interval. Use Caution/Monitor.
  
  eliglustat increases levels of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.

• elranatamab

  Monitor Closely (1)elranatamab will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Elranatamab causes cytokine release syndrome (CRS) that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. This is more likely to occur from initiation of elranatamab step-up dosing up to 14 days after the first treatment dose and during and after CRS.

• eluxadoline

  Monitor Closely (1)eluxadoline increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution when CYP3A substrates that have a narrow therapeutic index are coadministered with eluxadoline.Serious - Use Alternative (1)tacrolimus increases levels of eluxadoline by decreasing metabolism. Avoid or Use Alternate Drug. Decrease eluxadoline dose to 75 mg PO BID if coadministered with OATP1B1 inhibitors. .

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (2)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
  
  tacrolimus and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• encorafenib

  Monitor Closely (1)encorafenib, tacrolimus. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.Serious - Use Alternative (1)encorafenib and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• entecavir

  Minor (1)tacrolimus, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.

• entrectinib

  Serious - Use Alternative (1)entrectinib and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• enzalutamide

  Serious - Use Alternative (1)enzalutamide will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• epcoritamab

  Monitor Closely (1)epcoritamab, tacrolimus. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Epcoritamab causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. .

• erdafitinib

  Serious - Use Alternative (2)erdafitinib, tacrolimus. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with erdafitinib and sensitive CYP3A4 substrates with narrow therapeutic indices. Erdafitinib may altered plasma concentrations of CYP3A4 substrates, leading to either loss of activity or increased toxicity of the substrate.
  
  erdafitinib will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.

• eribulin

  Serious - Use Alternative (1)eribulin and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin base

  Monitor Closely (1)erythromycin base will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin base will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  tacrolimus and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  Monitor Closely (1)erythromycin ethylsuccinate will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin ethylsuccinate will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  tacrolimus and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  tacrolimus and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  Monitor Closely (1)erythromycin stearate will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin stearate will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  tacrolimus and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

• escitalopram

  Monitor Closely (1)escitalopram increases toxicity of tacrolimus by QTc interval. Use Caution/Monitor.

• eslicarbazepine acetate

  Monitor Closely (1)eslicarbazepine acetate will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• esomeprazole

  Monitor Closely (1)esomeprazole will increase the level or effect of tacrolimus by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Concomitant administration may increase tacrolimus whole blood concentrations, particularly in intermediate or poor metabolizers of CYP2C19

• estradiol

  Monitor Closely (1)tacrolimus will increase the level or effect of estradiol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• estrogens conjugated synthetic

  Monitor Closely (1)tacrolimus will increase the level or effect of estrogens conjugated synthetic by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• estrogens esterified

  Monitor Closely (1)tacrolimus will increase the level or effect of estrogens esterified by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• estropipate

  Monitor Closely (1)tacrolimus will increase the level or effect of estropipate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• etanercept

  Serious - Use Alternative (1)etanercept and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• ethinylestradiol

  Monitor Closely (1)ethinylestradiol will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• etodolac

  Serious - Use Alternative (1)etodolac, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• etoposide

  Monitor Closely (1)tacrolimus will increase the level or effect of etoposide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• etravirine

  Monitor Closely (1)etravirine will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• everolimus

  Monitor Closely (1)tacrolimus and everolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. If used for liver transplant immunosuppression (Zortress), reduce tacrolimus dose and use target serum concentration to reduce nephrotoxicity.

• ezogabine

  Monitor Closely (1)ezogabine, tacrolimus. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  Monitor Closely (1)fedratinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

• felodipine

  Monitor Closely (1)felodipine will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• fenoprofen

  Serious - Use Alternative (1)fenoprofen, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• ferric maltol

  Monitor Closely (1)ferric maltol, tacrolimus. Either increases levels of the other by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Coadministration of ferric maltol with certain oral medications may decrease the bioavailability of either ferric maltol and some oral drugs. For oral drugs where reductions in bioavailability may cause clinically significant effects on its safety or efficacy, separate administration of ferric maltol from these drugs. Duration of separation may depend on the absorption of the medication concomitantly administered (eg, time to peak concentration, whether the drug is an immediate or extended release product).

• fexinidazole

  Serious - Use Alternative (2)fexinidazole and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
  
  fexinidazole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• fexofenadine

  Minor (1)tacrolimus will increase the level or effect of fexofenadine by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• finerenone

  Monitor Closely (2)tacrolimus will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.
  
  tacrolimus and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.

• fingolimod

  Monitor Closely (2)tacrolimus increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .
  
  fingolimod and tacrolimus both increase QTc interval. Use Caution/Monitor.

• flecainide

  Serious - Use Alternative (1)tacrolimus and flecainide both increase QTc interval. Avoid or Use Alternate Drug.

• flibanserin

  Monitor Closely (1)tacrolimus will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

• fluconazole

  Contraindicated (1)tacrolimus and fluconazole both increase QTc interval. Contraindicated.Monitor Closely (1)fluconazole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• fludrocortisone

  Monitor Closely (2)fludrocortisone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of fludrocortisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Minor (1)fludrocortisone, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• fluoxetine

  Monitor Closely (1)tacrolimus and fluoxetine both increase QTc interval. Use Caution/Monitor.

• fluoxymesterone

  Minor (1)fluoxymesterone increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• fluphenazine

  Monitor Closely (1)tacrolimus and fluphenazine both increase QTc interval. Use Caution/Monitor.

• flurbiprofen

  Serious - Use Alternative (1)flurbiprofen, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• fluvastatin

  Monitor Closely (1)tacrolimus increases toxicity of fluvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• fluvoxamine

  Monitor Closely (2)fluvoxamine will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus and fluvoxamine both increase QTc interval. Use Caution/Monitor.

• food

  Minor (1)food decreases levels of tacrolimus by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• fosamprenavir

  Monitor Closely (1)fosamprenavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• fosaprepitant

  Monitor Closely (1)fosaprepitant will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• foscarnet

  Monitor Closely (1)foscarnet and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.Serious - Use Alternative (1)tacrolimus and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.

• fosphenytoin

  Monitor Closely (2)fosphenytoin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  fosphenytoin will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• fostamatinib

  Monitor Closely (1)fostamatinib will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.

• fostemsavir

  Monitor Closely (1)tacrolimus and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• gemifloxacin

  Monitor Closely (1)gemifloxacin and tacrolimus both increase QTc interval. Use Caution/Monitor.

• gemtuzumab

  Monitor Closely (1)tacrolimus and gemtuzumab both increase QTc interval. Use Caution/Monitor.

• gentamicin

  Monitor Closely (2)tacrolimus will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  gentamicin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• gilteritinib

  Monitor Closely (1)gilteritinib and tacrolimus both increase QTc interval. Use Caution/Monitor.

• glasdegib

  Serious - Use Alternative (1)tacrolimus and glasdegib both increase QTc interval. Avoid or Use Alternate Drug.

• glatiramer

  Serious - Use Alternative (1)glatiramer and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• glecaprevir/pibrentasvir

  Monitor Closely (2)tacrolimus will increase the level or effect of glecaprevir/pibrentasvir by decreasing metabolism. Use Caution/Monitor. Caution when coadministering glecaprevir/pibrentasvir with OATP1B1/OATP1B3 inhibitors
  
  glecaprevir/pibrentasvir will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• glimepiride

  Minor (1)glimepiride increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• glipizide

  Minor (1)glipizide increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• glofitamab

  Monitor Closely (1)glofitamab, tacrolimus. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Glofitamab causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. .

• glyburide

  Minor (1)glyburide increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• glycerol phenylbutyrate

  Monitor Closely (1)glycerol phenylbutyrate will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Glycerol phenylbutyrate is a weak inducer of CYP3A4. Monitor for decreased efficacy of CYP3A4 substrates that have a narrow therapeutic index.

• golimumab

  Serious - Use Alternative (1)golimumab and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• goserelin

  Monitor Closely (1)tacrolimus and goserelin both increase QTc interval. Use Caution/Monitor.

• granisetron

  Monitor Closely (1)granisetron and tacrolimus both increase QTc interval. Use Caution/Monitor.

• grapefruit

  Monitor Closely (1)grapefruit will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• griseofulvin

  Monitor Closely (1)griseofulvin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• guselkumab

  Monitor Closely (1)guselkumab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of guselkumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• haemophilus influenzae type b vaccine

  Monitor Closely (1)tacrolimus decreases effects of haemophilus influenzae type b vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored. .

• haloperidol

  Monitor Closely (1)haloperidol and tacrolimus both increase QTc interval. Use Caution/Monitor.

• hepatitis A vaccine inactivated

  Serious - Use Alternative (1)tacrolimus decreases effects of hepatitis A vaccine inactivated by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• hepatitis a/b vaccine

  Serious - Use Alternative (1)tacrolimus decreases effects of hepatitis a/b vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• hepatitis a/typhoid vaccine

  Serious - Use Alternative (1)tacrolimus decreases effects of hepatitis a/typhoid vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• hepatitis b vaccine

  Serious - Use Alternative (1)tacrolimus decreases effects of hepatitis b vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• histrelin

  Monitor Closely (1)tacrolimus and histrelin both increase QTc interval. Use Caution/Monitor.

• human papillomavirus vaccine, nonavalent

  Serious - Use Alternative (1)tacrolimus decreases effects of human papillomavirus vaccine, nonavalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.

• human papillomavirus vaccine, quadrivalent

  Serious - Use Alternative (1)tacrolimus decreases effects of human papillomavirus vaccine, quadrivalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.

• hydrocortisone

  Monitor Closely (2)hydrocortisone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of hydrocortisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Minor (1)hydrocortisone, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• hydroxychloroquine sulfate

  Serious - Use Alternative (2)hydroxychloroquine sulfate and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
  
  hydroxychloroquine sulfate and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyzine

  Monitor Closely (1)hydroxyzine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• ibuprofen

  Serious - Use Alternative (1)ibuprofen, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• ibuprofen IV

  Serious - Use Alternative (1)ibuprofen IV, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• ibutilide

  Serious - Use Alternative (1)tacrolimus and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.

• idecabtagene vicleucel

  Serious - Use Alternative (1)tacrolimus, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• idelalisib

  Serious - Use Alternative (1)idelalisib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• ifosfamide

  Monitor Closely (1)ifosfamide, tacrolimus. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Ifosfamide may enhance the toxicities of myelosuppressive agents. Monitor for increased risk of myelosuppression.Serious - Use Alternative (1)ifosfamide, tacrolimus. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• iloperidone

  Monitor Closely (1)iloperidone increases levels of tacrolimus by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.Serious - Use Alternative (1)tacrolimus and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.

• imatinib

  Monitor Closely (1)tacrolimus will increase the level or effect of imatinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• imipramine

  Monitor Closely (1)tacrolimus and imipramine both increase QTc interval. Use Caution/Monitor.

• indacaterol, inhaled

  Monitor Closely (1)indacaterol, inhaled, tacrolimus. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• indinavir

  Monitor Closely (2)indinavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  indinavir will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• indomethacin

  Serious - Use Alternative (1)indomethacin, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• infliximab

  Serious - Use Alternative (1)infliximab and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• influenza virus vaccine quadrivalent

  Serious - Use Alternative (1)tacrolimus decreases effects of influenza virus vaccine quadrivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• influenza virus vaccine quadrivalent, adjuvanted

  Serious - Use Alternative (1)tacrolimus decreases effects of influenza virus vaccine quadrivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

• influenza virus vaccine quadrivalent, cell-cultured

  Serious - Use Alternative (1)tacrolimus decreases effects of influenza virus vaccine quadrivalent, cell-cultured by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• influenza virus vaccine quadrivalent, intranasal

  Serious - Use Alternative (1)tacrolimus decreases effects of influenza virus vaccine quadrivalent, intranasal by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• influenza virus vaccine quadrivalent, recombinant

  Monitor Closely (1)tacrolimus decreases effects of influenza virus vaccine quadrivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.

• influenza virus vaccine trivalent

  Serious - Use Alternative (1)tacrolimus decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• influenza virus vaccine trivalent, adjuvanted

  Serious - Use Alternative (1)tacrolimus decreases effects of influenza virus vaccine trivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

• influenza virus vaccine trivalent, recombinant

  Monitor Closely (1)tacrolimus decreases effects of influenza virus vaccine trivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.

• inotuzumab

  Serious - Use Alternative (1)tacrolimus and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.

• ioversol

  Serious - Use Alternative (1)ioversol and tacrolimus both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

• irinotecan

  Monitor Closely (1)tacrolimus will increase the level or effect of irinotecan by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• irinotecan liposomal

  Monitor Closely (1)tacrolimus will increase the level or effect of irinotecan liposomal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• isavuconazonium sulfate

  Monitor Closely (3)tacrolimus will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  isavuconazonium sulfate will increase the level or effect of tacrolimus by Other (see comment). Use Caution/Monitor. Isavuconazonium sulfate, an inhibitor of P-gp and CYP3A4, may increase the effects or levels of sensitive P-gp or CYP3A4 substrates, which may require dose adjustment.
  
  tacrolimus and isavuconazonium sulfate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor.

• isoflurane

  Serious - Use Alternative (1)isoflurane and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• isoniazid

  Monitor Closely (1)isoniazid will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• istradefylline

  Monitor Closely (2)istradefylline will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
  
  istradefylline will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

• itraconazole

  Serious - Use Alternative (1)itraconazole and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• ivacaftor

  Monitor Closely (1)ivacaftor increases levels of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.

• ivermectin

  Monitor Closely (1)tacrolimus will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ivosidenib

  Serious - Use Alternative (2)ivosidenib and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
  
  ivosidenib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• ixekizumab

  Monitor Closely (1)ixekizumab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, ixekizumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of ixekizumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• Japanese encephalitis virus vaccine

  Serious - Use Alternative (1)tacrolimus decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• ketoconazole

  Monitor Closely (1)ketoconazole will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)ketoconazole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• ketoprofen

  Serious - Use Alternative (1)ketoprofen, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• ketorolac

  Serious - Use Alternative (1)ketorolac, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• lansoprazole

  Monitor Closely (1)lansoprazole will increase the level or effect of tacrolimus by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Concomitant administration may increase tacrolimus whole blood concentrations, particularly in intermediate or poor metabolizers of CYP2C19

• lapatinib

  Monitor Closely (2)lapatinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  lapatinib will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)tacrolimus and lapatinib both increase QTc interval. Avoid or Use Alternate Drug.

• larotrectinib

  Monitor Closely (1)larotrectinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lasmiditan

  Serious - Use Alternative (1)lasmiditan increases levels of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• lefamulin

  Contraindicated (1)lefamulin will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.Serious - Use Alternative (1)tacrolimus and lefamulin both increase QTc interval. Avoid or Use Alternate Drug.

• leflunomide

  Serious - Use Alternative (1)leflunomide and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• lenacapavir

  Monitor Closely (1)lenacapavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.

• lenvatinib

  Serious - Use Alternative (1)tacrolimus and lenvatinib both increase QTc interval. Avoid or Use Alternate Drug.

• letermovir

  Monitor Closely (2)tacrolimus increases levels of letermovir by decreasing metabolism. Use Caution/Monitor. Coadminstration of letermovir, an OATP1B1/3 substrate, with OATP1B1/3 inhibitors may increase letermovir plasma concentrations.
  
  letermovir increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor tacrolimus plasma concentrations during treatment and after discontinuation of letemovir and adjust dose of tacrolimus accordingly.

• leuprolide

  Monitor Closely (1)tacrolimus and leuprolide both increase QTc interval. Use Caution/Monitor.

• levamlodipine

  Monitor Closely (1)levamlodipine will increase the level or effect of tacrolimus by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when coadministered. Frequent monitoring of trough blood levels of cyclosporine and tacrolimus is recommended and adjust the dose when appropriate.

• levofloxacin

  Monitor Closely (1)tacrolimus and levofloxacin both increase QTc interval. Use Caution/Monitor.

• levoketoconazole

  Monitor Closely (1)levoketoconazole will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)levoketoconazole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• lisocabtagene maraleucel

  Serious - Use Alternative (1)tacrolimus, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• lithium

  Monitor Closely (1)lithium and tacrolimus both increase QTc interval. Use Caution/Monitor.

• lofexidine

  Serious - Use Alternative (1)tacrolimus and lofexidine both increase QTc interval. Avoid or Use Alternate Drug.

• lomitapide

  Monitor Closely (1)lomitapide increases levels of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing dose when used concomitantly with lomitapide.

• lomustine

  Monitor Closely (1)lomustine and tacrolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects.

• lonafarnib

  Monitor Closely (1)lonafarnib will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.Serious - Use Alternative (1)lonafarnib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

• lonapegsomatropin

  Monitor Closely (1)lonapegsomatropin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• loperamide

  Monitor Closely (2)tacrolimus will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  tacrolimus and loperamide both increase QTc interval. Use Caution/Monitor.

• lopinavir

  Serious - Use Alternative (2)lopinavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  tacrolimus and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.

• loratadine

  Monitor Closely (1)loratadine will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Minor (1)tacrolimus will increase the level or effect of loratadine by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• lorlatinib

  Serious - Use Alternative (1)lorlatinib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid use of lorlatinib with CYP3A substrates, where minimal concentration changes may lead to serious therapeutic failures of the substrate. If concomitant use is unavoidable, increase CYP3A substrate dosage in accordance with approved product labeling.

• lovastatin

  Monitor Closely (1)lovastatin will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• lumacaftor/ivacaftor

  Serious - Use Alternative (1)lumacaftor/ivacaftor will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Lumacaftor is a strong inducer of CYP3A. Avoid coadministration with sensitive CYP3A substrates or CYP3A substrates with a narrow therapeutic index.

• lumefantrine

  Monitor Closely (1)lumefantrine will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• macimorelin

  Serious - Use Alternative (1)macimorelin and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maitake

  Monitor Closely (1)tacrolimus increases and maitake decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• maprotiline

  Monitor Closely (1)tacrolimus and maprotiline both increase QTc interval. Use Caution/Monitor.

• maraviroc

  Monitor Closely (1)tacrolimus will increase the level or effect of maraviroc by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• marijuana

  Monitor Closely (1)marijuana will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• measles (rubeola) vaccine

  Serious - Use Alternative (1)tacrolimus decreases effects of measles (rubeola) vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• measles mumps and rubella vaccine, live

  Serious - Use Alternative (1)tacrolimus decreases effects of measles mumps and rubella vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• measles, mumps, rubella and varicella vaccine, live

  Serious - Use Alternative (1)tacrolimus decreases effects of measles, mumps, rubella and varicella vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• meclofenamate

  Serious - Use Alternative (1)meclofenamate, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• mefenamic acid

  Serious - Use Alternative (1)mefenamic acid, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• mefloquine

  Serious - Use Alternative (1)mefloquine increases toxicity of tacrolimus by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• meloxicam

  Serious - Use Alternative (1)meloxicam, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• melphalan

  Serious - Use Alternative (1)melphalan, tacrolimus. Either decreases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects.

• meningococcal A C Y and W-135 polysaccharide vaccine combined

  Serious - Use Alternative (1)tacrolimus decreases effects of meningococcal A C Y and W-135 polysaccharide vaccine combined by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• meningococcal group B vaccine

  Monitor Closely (1)tacrolimus decreases effects of meningococcal group B vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Individuals with altered immunocompetence may have reduced immune responses to the vaccine.

• mercaptopurine

  Monitor Closely (1)mercaptopurine and tacrolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

• mesterolone

  Minor (1)mesterolone increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• mestranol

  Monitor Closely (1)tacrolimus will increase the level or effect of mestranol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• metformin

  Monitor Closely (1)tacrolimus decreases effects of metformin by pharmacodynamic antagonism. Use Caution/Monitor.

• methadone

  Serious - Use Alternative (1)tacrolimus and methadone both increase QTc interval. Avoid or Use Alternate Drug.

• methotrexate

  Monitor Closely (1)methotrexate and tacrolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Combination may increase risk of myelosuppression.

• methoxyflurane

  Monitor Closely (1)methoxyflurane and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• methylprednisolone

  Monitor Closely (2)methylprednisolone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of methylprednisolone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Minor (1)methylprednisolone, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• methyltestosterone

  Monitor Closely (1)methyltestosterone increases effects of tacrolimus by decreasing metabolism. Use Caution/Monitor.

• metoclopramide intranasal

  Monitor Closely (1)metoclopramide intranasal will increase the level or effect of tacrolimus by Other (see comment). Use Caution/Monitor. Metoclopramide may increase the absorption of tacrolimus. Monitor therapeutic drug concentrations and adjust the dose as needed.

• metronidazole

  Monitor Closely (1)metronidazole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• miconazole vaginal

  Monitor Closely (1)miconazole vaginal will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• midostaurin

  Serious - Use Alternative (1)tacrolimus and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.

• mifepristone

  Contraindicated (1)mifepristone increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated with CYP3A substrates that have a narrow therapeutic index .

• mirtazapine

  Monitor Closely (1)mirtazapine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• mitotane

  Monitor Closely (1)mitotane decreases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• mobocertinib

  Serious - Use Alternative (2)mobocertinib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, increase CYP3A4 substrate dosage in accordance with its prescribing information.
  
  mobocertinib and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• momelotinib

  Monitor Closely (1)tacrolimus increases toxicity of momelotinib by Other (see comment). Use Caution/Monitor. Comment: OATP1B1/B3 inhibitor increases momelotinib (OATP1B1/B3 subtrate) plasma concentrations, which may increase the risk of adverse reactions with momelotinib.

• moxifloxacin

  Serious - Use Alternative (1)tacrolimus and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• muromonab CD3

  Serious - Use Alternative (1)muromonab CD3 and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• mycophenolate

  Serious - Use Alternative (1)mycophenolate and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• nabumetone

  Serious - Use Alternative (1)nabumetone, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• nafcillin

  Monitor Closely (1)nafcillin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• naldemedine

  Monitor Closely (1)tacrolimus increases levels of naldemedine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with P-gp inhibitors.

• naproxen

  Serious - Use Alternative (1)naproxen, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• nefazodone

  Monitor Closely (1)nefazodone will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)nefazodone will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nelfinavir

  Monitor Closely (2)nelfinavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of nelfinavir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• neomycin PO

  Contraindicated (1)neomycin PO and tacrolimus both increase nephrotoxicity and/or ototoxicity. Contraindicated.Monitor Closely (1)tacrolimus will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• nevirapine

  Monitor Closely (1)nevirapine will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nicardipine

  Monitor Closely (2)nicardipine will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  nicardipine increases levels of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nifedipine

  Monitor Closely (2)nifedipine will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  nifedipine will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• nilotinib

  Monitor Closely (2)nilotinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  nilotinib will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)tacrolimus and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

• nintedanib

  Monitor Closely (1)tacrolimus increases levels of nintedanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. If nintedanib adverse effects occur, management may require interruption, dose reduction, or discontinuation of therapy .

• nirmatrelvir

  Serious - Use Alternative (1)nirmatrelvir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid, decrease tacrolimus dose by one-third. Strong CYP3A inhibitors may increase tacrolimus whole blood trough concentrations and increase risk of serious adverse reactions (eg, neurotoxicity, QT prolongation). A rapid, sharp rise in tacrolimus levels may occur early, despite an immediate reduction of tacrolimus dose.

• nirmatrelvir/ritonavir

  Serious - Use Alternative (1)nirmatrelvir/ritonavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid, decrease tacrolimus dose by one-third. Strong CYP3A inhibitors may increase tacrolimus whole blood trough concentrations and increase risk of serious adverse reactions (eg, neurotoxicity, QT prolongation). A rapid, sharp rise in tacrolimus levels may occur early, despite an immediate reduction of tacrolimus dose.

• nitazoxanide

  Monitor Closely (1)nitazoxanide, tacrolimus. Either increases levels of the other by Mechanism: plasma protein binding competition. Use Caution/Monitor.

• nortriptyline

  Monitor Closely (1)tacrolimus and nortriptyline both increase QTc interval. Use Caution/Monitor.

• ocrelizumab

  Monitor Closely (1)tacrolimus and ocrelizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration of ocrelizumab with immunosuppressants may increase the risk of immunosuppression.

• octreotide

  Monitor Closely (1)tacrolimus and octreotide both increase QTc interval. Use Caution/Monitor.

• ofatumumab SC

  Monitor Closely (1)ofatumumab SC, tacrolimus. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

• ofloxacin

  Monitor Closely (1)tacrolimus and ofloxacin both increase QTc interval. Use Caution/Monitor.

• olanzapine

  Monitor Closely (1)olanzapine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• olaparib

  Monitor Closely (1)tacrolimus and olaparib both increase pharmacodynamic synergism. Use Caution/Monitor. Coadministration with other other myelosuppressive anticancer agents, including DNA damaging agents, may potentiate and prolongate the myelosuppressive toxicity.

• olodaterol inhaled

  Monitor Closely (1)tacrolimus and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• olutasidenib

  Serious - Use Alternative (1)olutasidenib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of olutasidenib (a CYP3A4 inducer) with sensitive CYP3A substrates unless otherwise instructed in substrates prescribing information. If unavoidable, monitor for loss of therapeutic effect of sensitive CYP3A4 substrates.

• omaveloxolone

  Monitor Closely (1)omaveloxolone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Omaveloxolone may reduce systemic exposure of sensitive CYP3A4 substrates. Check prescribing information of substrate if dosage modification is needed.

• ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)

  Monitor Closely (1)ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. When initiating therapy with Viekira Pak, the dose of tacrolimus needs to be reduced; do not administer tacrolimus on the day Viekira Pak is initiated; beginning the day after Viekira Pak is initiated, reinitiate tacrolimus at a reduced dose based on tacrolimus blood concentrations; typical tacrolimus dosing is 0.5 mg q7days; measure tacrolimus blood concentrations and adjust dose or dosing frequency to determine subsequent dose modifications; upon completion of Viekira Pak, the appropriate time to resume pre-Viekira Pak dose of tacrolimus should be guided by assessment of blood concentrations

• omeprazole

  Monitor Closely (1)omeprazole will increase the level or effect of tacrolimus by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Concomitant administration may increase tacrolimus whole blood concentrations, particularly in intermediate or poor metabolizers of CYP2C19

• ondansetron

  Serious - Use Alternative (1)ondansetron and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

• oritavancin

  Monitor Closely (1)oritavancin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Oritavancin is a weak CYP3A4 inducer; caution if coadministered with CYP3A4 substrates that have a narrow therapeutic index

• osilodrostat

  Monitor Closely (1)osilodrostat and tacrolimus both increase QTc interval. Use Caution/Monitor.

• osimertinib

  Monitor Closely (1)osimertinib and tacrolimus both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• ospemifene

  Monitor Closely (1)tacrolimus, ospemifene. Either increases levels of the other by plasma protein binding competition. Modify Therapy/Monitor Closely.

• oxaliplatin

  Monitor Closely (1)oxaliplatin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.Serious - Use Alternative (2)oxaliplatin and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects.
  
  oxaliplatin and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• oxandrolone

  Minor (1)oxandrolone increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• oxaprozin

  Serious - Use Alternative (1)oxaprozin, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• oxcarbazepine

  Monitor Closely (1)oxcarbazepine will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• oxymetholone

  Minor (1)oxymetholone increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• ozanimod

  Monitor Closely (2)ozanimod, tacrolimus. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration with immunosuppressive therapies may increase the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs in order to avoid unintended additive immunosuppressive effects.
  
  ozanimod and tacrolimus both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

• paclitaxel

  Monitor Closely (1)tacrolimus will increase the level or effect of paclitaxel by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• paclitaxel protein bound

  Monitor Closely (1)tacrolimus will increase the level or effect of paclitaxel protein bound by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• pacritinib

  Serious - Use Alternative (1)pacritinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• palbociclib

  Monitor Closely (1)palbociclib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. The dose of sensitive CYP3A substrates with a narrow therapeutic index may need to be reduced if coadministered with palbociclib

• paliperidone

  Monitor Closely (1)tacrolimus will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)tacrolimus and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.

• panobinostat

  Serious - Use Alternative (1)tacrolimus and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.

• pantoprazole

  Monitor Closely (1)pantoprazole will increase the level or effect of tacrolimus by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Concomitant administration may increase tacrolimus whole blood concentrations, particularly in intermediate or poor metabolizers of CYP2C19

• paromomycin

  Monitor Closely (2)tacrolimus will increase the level or effect of paromomycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  paromomycin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• pasireotide

  Serious - Use Alternative (1)tacrolimus and pasireotide both increase QTc interval. Avoid or Use Alternate Drug.

• pazopanib

  Serious - Use Alternative (1)tacrolimus and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.

• pentamidine

  Monitor Closely (1)pentamidine and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.Serious - Use Alternative (1)tacrolimus and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

• pentobarbital

  Monitor Closely (1)pentobarbital will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• peramivir

  Monitor Closely (1)tacrolimus increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

• perphenazine

  Monitor Closely (1)tacrolimus and perphenazine both increase QTc interval. Use Caution/Monitor.

• pexidartinib

  Serious - Use Alternative (1)pexidartinib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of pexidartinib (a CYP3A4 inducer) with sensitive CYP3A substrates may lead to serious therapeutic failures. If concomitant use is unavoidable, increase the CYP3A substrate dosage in accordance with approved product labeling.

• phenobarbital

  Monitor Closely (2)phenobarbital will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  phenobarbital will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• phenytoin

  Monitor Closely (2)phenytoin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  phenytoin will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Tacrolimus dosage requirements may be greater when administered concurrently with phenytoin.

• pimavanserin

  Serious - Use Alternative (1)tacrolimus and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.

• pimozide

  Serious - Use Alternative (1)tacrolimus and pimozide both increase QTc interval. Contraindicated.

• piroxicam

  Serious - Use Alternative (1)piroxicam, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• pirtobrutinib

  Monitor Closely (1)pirtobrutinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Pirtobrutinib (a CYP3A4 inhibitor) may increase plasma concentrations of sensitive CYP3A4 substrate which may increase the risk of adverse reactions related to these substrates.

• pitavastatin

  Monitor Closely (1)tacrolimus increases toxicity of pitavastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• pitolisant

  Monitor Closely (1)pitolisant will decrease the level or effect of tacrolimus by Other (see comment). Use Caution/Monitor. Pitolisant is a borderline/weak inducer of CYP3A4. Monitor sensitive CYP3A4 substrates for reduced effectiveness if coadministered.Serious - Use Alternative (1)tacrolimus and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• pneumococcal vaccine 13-valent

  Serious - Use Alternative (1)tacrolimus decreases effects of pneumococcal vaccine 13-valent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• pneumococcal vaccine heptavalent

  Serious - Use Alternative (1)tacrolimus decreases effects of pneumococcal vaccine heptavalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• pneumococcal vaccine polyvalent

  Serious - Use Alternative (1)tacrolimus decreases effects of pneumococcal vaccine polyvalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• poliovirus vaccine inactivated

  Monitor Closely (1)tacrolimus decreases effects of poliovirus vaccine inactivated by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored. .

• polymyxin B

  Monitor Closely (1)polymyxin B and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• pomalidomide

  Serious - Use Alternative (1)tacrolimus increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• ponatinib

  Monitor Closely (1)ponatinib increases levels of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ponesimod

  Monitor Closely (1)ponesimod and tacrolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.Serious - Use Alternative (1)tacrolimus and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• posaconazole

  Monitor Closely (2)posaconazole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of posaconazole by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)tacrolimus and posaconazole both increase QTc interval. Avoid or Use Alternate Drug.

• potassium citrate

  Monitor Closely (1)tacrolimus and potassium citrate both increase serum potassium. Use Caution/Monitor.

• potassium citrate/citric acid

  Monitor Closely (1)tacrolimus and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.

• potassium phosphates, IV

  Serious - Use Alternative (1)tacrolimus and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.

• pravastatin

  Monitor Closely (1)tacrolimus increases toxicity of pravastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• prednisolone

  Monitor Closely (1)tacrolimus will increase the level or effect of prednisolone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Minor (1)prednisolone, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• prednisone

  Monitor Closely (2)prednisone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of prednisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Minor (1)prednisone, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• primaquine

  Monitor Closely (1)primaquine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• primidone

  Monitor Closely (1)primidone will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• procainamide

  Serious - Use Alternative (1)tacrolimus and procainamide both increase QTc interval. Avoid or Use Alternate Drug.

• prochlorperazine

  Monitor Closely (1)tacrolimus and prochlorperazine both decrease QTc interval. Use Caution/Monitor.

• promethazine

  Monitor Closely (1)tacrolimus and promethazine both decrease QTc interval. Use Caution/Monitor.

• propafenone

  Serious - Use Alternative (1)tacrolimus and propafenone both increase QTc interval. Avoid or Use Alternate Drug.

• protriptyline

  Serious - Use Alternative (1)tacrolimus and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• pyrazinamide

  Minor (1)pyrazinamide decreases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• quercetin

  Monitor Closely (1)quercetin will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• quetiapine

  Monitor Closely (1)quetiapine, tacrolimus. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinidine

  Serious - Use Alternative (2)tacrolimus and quinidine both increase QTc interval. Avoid or Use Alternate Drug.
  
  quinidine will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• quinine

  Monitor Closely (1)tacrolimus and quinine both increase QTc interval. Use Caution/Monitor.

• quinupristin/dalfopristin

  Monitor Closely (1)quinupristin/dalfopristin will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• quizartinib

  Monitor Closely (1)quizartinib, tacrolimus. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.

• rabeprazole

  Monitor Closely (2)rabeprazole, tacrolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Contomitant use of agents that can cause magnesium loss can result in hypomagnesemia.
  
  rabeprazole will increase the level or effect of tacrolimus by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Concomitant administration may increase tacrolimus whole blood concentrations, particularly in intermediate or poor metabolizers of CYP2C19

• rabies vaccine

  Serious - Use Alternative (1)tacrolimus decreases effects of rabies vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants may interfere with development of active immunity.

• rabies vaccine chick embryo cell derived

  Serious - Use Alternative (1)tacrolimus decreases effects of rabies vaccine chick embryo cell derived by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• ranolazine

  Monitor Closely (1)ranolazine will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)tacrolimus and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.

• revefenacin

  Serious - Use Alternative (1)tacrolimus increases levels of revefenacin by Other (see comment). Avoid or Use Alternate Drug. Comment: OATP1B1 and OATP1B3 transport inhibitors may increase systemic exposure of revefenacin's active metabolite. Coadministration not recommended.

• ribociclib

  Monitor Closely (1)ribociclib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Caution if ribociclib is coadministered with sensitive CYP3A4 substrates that have a narrow therapeutic index. Dose reduction for sensitive CYP3A4 substrates may be needed.Serious - Use Alternative (1)ribociclib increases toxicity of tacrolimus by QTc interval. Avoid or Use Alternate Drug.

• rifabutin

  Serious - Use Alternative (1)rifabutin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• rifampin

  Monitor Closely (1)rifampin will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)rifampin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• rifapentine

  Monitor Closely (1)rifapentine will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifaximin

  Monitor Closely (1)tacrolimus increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• rilonacept

  Serious - Use Alternative (1)rilonacept and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• rilpivirine

  Monitor Closely (1)rilpivirine increases toxicity of tacrolimus by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

• rimegepant

  Serious - Use Alternative (1)tacrolimus will increase the level or effect of rimegepant by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• riociguat

  Serious - Use Alternative (1)tacrolimus will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed

• risperidone

  Monitor Closely (2)tacrolimus will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  tacrolimus and risperidone both increase QTc interval. Use Caution/Monitor.

• ritlecitinib

  Monitor Closely (1)ritlecitinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Ritlecitinib inhibits CYP3A4 substrates; coadministration increases AUC and peak plasma concentration sensitive substrates, which may increase risk of adverse reactions. Additional monitoring and dosage adjustment may be needed in accordance with product labeling of CYP3A substrates.

• ritonavir

  Monitor Closely (2)ritonavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  ritonavir will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• romidepsin

  Monitor Closely (1)tacrolimus will increase the level or effect of romidepsin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)tacrolimus and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.

• ropeginterferon alfa 2b

  Serious - Use Alternative (1)ropeginterferon alfa 2b, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.

• rotavirus oral vaccine, live

  Serious - Use Alternative (1)tacrolimus decreases effects of rotavirus oral vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• roxithromycin

  Monitor Closely (1)roxithromycin increases levels of tacrolimus by decreasing metabolism. Use Caution/Monitor.

• rubella vaccine

  Serious - Use Alternative (1)tacrolimus decreases effects of rubella vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• rucaparib

  Monitor Closely (1)rucaparib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

• rufinamide

  Monitor Closely (1)rufinamide will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• sacubitril/valsartan

  Monitor Closely (1)tacrolimus will increase the level or effect of sacubitril/valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• saquinavir

  Contraindicated (2)saquinavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  tacrolimus and saquinavir both increase QTc interval. Contraindicated.Monitor Closely (1)tacrolimus will increase the level or effect of saquinavir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• sarecycline

  Monitor Closely (1)sarecycline will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

• sarilumab

  Monitor Closely (1)sarilumab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of cytokines such as IL-6. Elevated IL-6 concentration may down-regulate CYP activity, such as in patients with RA, and, hence, increase drug levels compared with subjects without RA. Blockade of IL-6 signaling by IL-6 antagonists (eg, sarilumab) might reverse the inhibitory effect of IL-6 and restore CYP activity, leading to decreased drug concentrations. Caution when initiating or discontinuing sarilumab if coadministered with CYP450 substrates, especially those with a narrow therapeutic index.

• schisandra

  Monitor Closely (1)schisandra will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• secobarbital

  Monitor Closely (1)secobarbital will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• secukinumab

  Monitor Closely (1)secukinumab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• selpercatinib

  Monitor Closely (1)selpercatinib increases toxicity of tacrolimus by QTc interval. Use Caution/Monitor.

• sertraline

  Monitor Closely (1)sertraline and tacrolimus both increase QTc interval. Use Caution/Monitor.

• sevoflurane

  Serious - Use Alternative (1)sevoflurane and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• silodosin

  Monitor Closely (1)tacrolimus will increase the level or effect of silodosin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• siltuximab

  Monitor Closely (1)siltuximab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.

• simvastatin

  Monitor Closely (2)simvastatin will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  tacrolimus increases toxicity of simvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• siponimod

  Monitor Closely (1)siponimod and tacrolimus both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.Serious - Use Alternative (1)siponimod and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

• sipuleucel-T

  Monitor Closely (1)tacrolimus decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

• sirolimus

  Monitor Closely (1)sirolimus will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)sirolimus and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• smallpox (vaccinia) vaccine, live

  Serious - Use Alternative (1)tacrolimus decreases effects of smallpox (vaccinia) vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• solifenacin

  Monitor Closely (2)tacrolimus and solifenacin both increase QTc interval. Use Caution/Monitor.
  
  solifenacin and tacrolimus both increase QTc interval. Use Caution/Monitor.

• somapacitan

  Monitor Closely (1)somapacitan will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• somatrogon

  Monitor Closely (1)somatrogon will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• somatropin

  Monitor Closely (1)somatropin will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates

• sorafenib

  Monitor Closely (1)sorafenib and tacrolimus both increase QTc interval. Use Caution/Monitor.

• sotalol

  Serious - Use Alternative (1)tacrolimus and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

• sotorasib

  Serious - Use Alternative (2)sotorasib will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the CYP3A4 substrate for dosage modifications
  
  sotorasib will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

• spironolactone

  Monitor Closely (1)spironolactone will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. tacrolimus dose may need to be adjusted

• St John's Wort

  Monitor Closely (1)St John's Wort will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)St John's Wort will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  St John's Wort decreases levels of tacrolimus by increasing metabolism. Avoid or Use Alternate Drug.

• stiripentol

  Monitor Closely (2)stiripentol, tacrolimus. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
  
  stiripentol will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

• streptomycin

  Monitor Closely (2)tacrolimus will increase the level or effect of streptomycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  streptomycin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• streptozocin

  Monitor Closely (1)streptozocin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• sulbactam/durlobactam

  Serious - Use Alternative (1)tacrolimus will increase the level or effect of sulbactam/durlobactam by Other (see comment). Avoid or Use Alternate Drug. Sulbactam is predicted to have active secretion by OATP1 as a significant portion of total clearance; therefore, inhibition of OAT1 may increase sulbactam plasma concentrations

• sulindac

  Serious - Use Alternative (1)sulindac, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• sunitinib

  Monitor Closely (2)sunitinib and tacrolimus both increase QTc interval. Use Caution/Monitor.
  
  tacrolimus and sunitinib both increase QTc interval. Use Caution/Monitor.

• talquetamab

  Monitor Closely (1)talquetamab will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Talquetamab causes cytokine release syndrome (CRS) that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. This is more likely to occur from initiation of talquetamab step-up dosing up to 14 days after the first treatment dose and during and after CRS.

• tazemetostat

  Monitor Closely (2)tazemetostat will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  tacrolimus will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• teclistamab

  Monitor Closely (1)teclistamab will increase the level or effect of tacrolimus by altering metabolism. Use Caution/Monitor. Teclistamab causes release of cytokines that may suppress activity of CYP450 enzymes, resulting in increased exposure of CYP substrates. Monitor for increased concentrations or toxicities of sensitive CYP substrates. Adjust dose of CYP substrate drug as needed.

• tecovirimat

  Monitor Closely (1)tecovirimat will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• teduglutide

  Monitor Closely (1)teduglutide increases levels of tacrolimus by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.

• teicoplanin

  Serious - Use Alternative (1)tacrolimus and teicoplanin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

• telavancin

  Serious - Use Alternative (1)tacrolimus and telavancin both increase QTc interval. Avoid or Use Alternate Drug.

• telotristat ethyl

  Monitor Closely (1)telotristat ethyl will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Telotristat ethyl induces CYP3A4 and may reduce systemic exposure of sensitive CYP3A4 substrates. Monitor for suboptimal efficacy and consider increasing the dose of the CYP3A4 substrate.

• temsirolimus

  Serious - Use Alternative (1)tacrolimus and temsirolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• teniposide

  Monitor Closely (1)tacrolimus will increase the level or effect of teniposide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• tenofovir DF

  Monitor Closely (1)tacrolimus and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• testosterone

  Minor (1)testosterone increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• testosterone buccal system

  Minor (1)testosterone buccal system increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• testosterone topical

  Minor (1)testosterone topical increases effects of tacrolimus by decreasing metabolism. Minor/Significance Unknown.

• tetanus toxoid adsorbed or fluid

  Serious - Use Alternative (1)tacrolimus decreases effects of tetanus toxoid adsorbed or fluid by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• tetrabenazine

  Serious - Use Alternative (1)tacrolimus and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

• thioridazine

  Contraindicated (1)tacrolimus and thioridazine both increase QTc interval. Contraindicated.

• tick-borne encephalitis vaccine

  Serious - Use Alternative (1)tacrolimus decreases effects of tick-borne encephalitis vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• tinidazole

  Monitor Closely (2)tinidazole will increase the level or effect of tacrolimus by unknown mechanism. Use Caution/Monitor. Monitored for signs of calcineurin-inhibitor associated toxicities (eg, nephrotoxicity, cholestasis, paresthesias).
  
  tacrolimus will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tipranavir

  Monitor Closely (1)tipranavir, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Tacrolimus levels may incr or decr, due to contradictory effects of tipranavir on hepatic CYP3A4 and P glycoprotein.Serious - Use Alternative (1)tipranavir will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• tisagenlecleucel

  Serious - Use Alternative (1)tacrolimus, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• tobramycin

  Monitor Closely (2)tacrolimus will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  tacrolimus and tobramycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

• tocilizumab

  Serious - Use Alternative (1)tocilizumab and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• tofacitinib

  Serious - Use Alternative (1)tacrolimus, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• tolazamide

  Minor (1)tolazamide increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• tolbutamide

  Minor (1)tolbutamide increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

• tolmetin

  Serious - Use Alternative (1)tolmetin, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.

• tolvaptan

  Monitor Closely (2)tacrolimus will increase the level or effect of tolvaptan by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  tolvaptan will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• tongkat ali

  Serious - Use Alternative (1)tacrolimus and tongkat ali both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• topiramate

  Monitor Closely (1)topiramate will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• topotecan

  Serious - Use Alternative (1)tacrolimus will increase the level or effect of topotecan by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Product labeling for PO topotecan recommends avoiding concomitant use of P-gp inhibitors; the interaction with IV topotecan may be less severe but is still likely of clinical significance

• toremifene

  Serious - Use Alternative (1)tacrolimus and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

• trastuzumab

  Monitor Closely (1)trastuzumab, tacrolimus. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

• trastuzumab deruxtecan

  Monitor Closely (1)trastuzumab deruxtecan, tacrolimus. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

• travelers diarrhea and cholera vaccine inactivated

  Serious - Use Alternative (1)tacrolimus decreases effects of travelers diarrhea and cholera vaccine inactivated by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• trazodone

  Monitor Closely (1)trazodone will decrease the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)tacrolimus and trazodone both increase QTc interval. Avoid or Use Alternate Drug.

• triamcinolone acetonide injectable suspension

  Minor (1)triamcinolone acetonide injectable suspension, tacrolimus. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

• triclabendazole

  Monitor Closely (1)tacrolimus and triclabendazole both increase QTc interval. Use Caution/Monitor.

• trifluoperazine

  Monitor Closely (1)tacrolimus and trifluoperazine both decrease QTc interval. Use Caution/Monitor.

• trimipramine

  Monitor Closely (1)tacrolimus and trimipramine both increase QTc interval. Use Caution/Monitor.

• triptorelin

  Monitor Closely (1)tacrolimus and triptorelin both increase QTc interval. Use Caution/Monitor.

• trofinetide

  Monitor Closely (1)trofinetide will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor CYP3A4 substrates for which a small increase in plasma concentration may lead to serious toxicities if coadministered with trofinetide (a weak CYP3A4 inhibitor).

• tucatinib

  Monitor Closely (1)tucatinib will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.Serious - Use Alternative (1)tucatinib will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

• turmeric

  Monitor Closely (1)turmeric will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• typhoid polysaccharide vaccine

  Serious - Use Alternative (1)tacrolimus decreases effects of typhoid polysaccharide vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• typhoid vaccine live

  Serious - Use Alternative (1)tacrolimus decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• ublituximab

  Monitor Closely (1)ublituximab and tacrolimus both increase immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Owing to potential additive immunosuppressive effects, consider duration of effect and mechanism of action of these therapies if coadministered

• umeclidinium bromide/vilanterol inhaled

  Serious - Use Alternative (1)tacrolimus increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• upadacitinib

  Serious - Use Alternative (1)tacrolimus, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

• ustekinumab

  Monitor Closely (1)ustekinumab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.Serious - Use Alternative (1)tacrolimus and ustekinumab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

• valbenazine

  Monitor Closely (1)valbenazine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• vancomycin

  Monitor Closely (1)tacrolimus and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

• vandetanib

  Serious - Use Alternative (1)tacrolimus, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vardenafil

  Monitor Closely (1)tacrolimus and vardenafil both increase QTc interval. Use Caution/Monitor.

• varicella virus vaccine live

  Serious - Use Alternative (1)tacrolimus decreases effects of varicella virus vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• vemurafenib

  Serious - Use Alternative (1)tacrolimus and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.

• venetoclax

  Serious - Use Alternative (2)tacrolimus will increase the level or effect of venetoclax by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If a P-gp inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.
  
  venetoclax will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. In vitro data suggest venetoclax may inhibit P-gp substrates at therapeutic dose levels in the gut. Avoid coadministration of narrow therapeutic index P-gp substrates with venetoclax. If a narrow therapeutic index P-gp substrate must be used, it should be taken at least 6 hr before venetoclax.

• venlafaxine

  Monitor Closely (1)tacrolimus and venlafaxine both decrease QTc interval. Use Caution/Monitor.

• verapamil

  Monitor Closely (2)verapamil will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  verapamil will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• vilanterol/fluticasone furoate inhaled

  Serious - Use Alternative (1)tacrolimus increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vinblastine

  Monitor Closely (1)tacrolimus will increase the level or effect of vinblastine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• vincristine

  Monitor Closely (1)tacrolimus will increase the level or effect of vincristine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• vincristine liposomal

  Monitor Closely (1)tacrolimus will increase the level or effect of vincristine liposomal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• voclosporin

  Monitor Closely (2)voclosporin and tacrolimus both increase serum potassium. Use Caution/Monitor.
  
  voclosporin, tacrolimus. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole

  Monitor Closely (1)voriconazole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)tacrolimus and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.

• vorinostat

  Monitor Closely (2)tacrolimus and vorinostat both increase QTc interval. Use Caution/Monitor.
  
  vorinostat and tacrolimus both increase QTc interval. Use Caution/Monitor.

• voxelotor

  Serious - Use Alternative (1)voxelotor will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

• yellow fever vaccine

  Serious - Use Alternative (1)tacrolimus decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• zafirlukast

  Monitor Closely (1)zafirlukast will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ziprasidone

  Serious - Use Alternative (1)tacrolimus and ziprasidone both increase QTc interval. Contraindicated.

• zoster vaccine live

  Serious - Use Alternative (1)tacrolimus decreases effects of zoster vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

• zoster vaccine recombinant

  Monitor Closely (1)tacrolimus decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.