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Interaction between tacrolimus and erythromycin

I D Padhi¹, P Long, M Basha

¹Department of Pharmacy Services, Henry Ford Health Sciences Center, Detroit, MI 48202, USA.

Therapeutic Drug Monitoring

|February 1, 1997

Summary

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Concurrent use of erythromycin with tacrolimus can significantly increase tacrolimus levels, potentially leading to toxicity. Careful monitoring is crucial if these medications must be used together in transplant patients.

Area of Science:

Pharmacology
Nephrology
Transplant Medicine

Background:

Tacrolimus is a key immunosuppressant post-renal transplant.
Maintaining therapeutic tacrolimus levels is vital for graft survival.
Drug interactions can alter tacrolimus pharmacokinetics.

Observation:

A renal transplant patient on tacrolimus developed acute symptoms.
Erythromycin was initiated for suspected pneumonia.
Whole blood tacrolimus concentrations drastically increased (>60.0 ng/ml) during erythromycin therapy.

Findings:

Erythromycin co-administration led to a significant elevation in tacrolimus levels.
Discontinuation of erythromycin and dose reduction normalized tacrolimus concentrations.
Tacrolimus levels returned to baseline after erythromycin was stopped.

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Implications:

Concurrent use of erythromycin and tacrolimus should be avoided.
Close monitoring of tacrolimus levels, renal function, and urine output is essential if co-administration is necessary.
This interaction highlights the importance of medication review in transplant recipients.