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Carbamazepine Extended-Release Capsules (Carbatrol) and Tacrolimus Injection

Determining the interaction of Carbamazepine Extended-Release Capsules (Carbatrol) and Tacrolimus Injection and the possibility of their joint administration.

Check result:

Carbamazepine Extended-Release Capsules (Carbatrol) <> Tacrolimus Injection

Relevance: 10.10.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using carBAMazepine together with tacrolimus can add to the risk of organ rejection associated with low tacrolimus levels. This combination can also increase your risk of a dangerous side effect on your kidneys. If your doctor does prescribe these medications together, you may need a dose adjustment or special tests to safely take both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR CLOSELY: Coadministration with potent inducers of CYP450 3A4 and/or P-glycoprotein may significantly decrease the plasma concentrations and pharmacologic effects of tacrolimus. The mechanism probably involves reduced absorption as well as accelerated clearance of tacrolimus due to induction of both intestinal P-glycoprotein drug efflux transporter and hepatic/intestinal CYP450 3A4 isoenzymes. In a study of six healthy volunteers, a potent inducer of CYP450 3A4 and P-gp, rifampin (600 mg daily for 18 days) increased the average clearance of tacrolimus (0.1 mg/kg orally and 0.025 mg/kg/4 hours intravenously) by 47% and decreased its oral bioavailability from 14% to 7%. There have been case reports of transplant patients whose tacrolimus blood levels dropped significantly or became subtherapeutic as early as two days following the initiation of rifampin, subsequently requiring discontinuation of rifampin or substantial increases (up to ten-fold over several months) in tacrolimus dosage.

MANAGEMENT: Given the risk of organ rejection associated with inadequate immunosuppressant levels, caution is advised if tacrolimus must be coadministered with potent inducers of CYP450 3A4 and/or P-gp. Tacrolimus blood levels should be closely monitored and the dosage adjusted accordingly, particularly following initiation or discontinuation of inducer therapy in patients who are stabilized on their anti-rejection regimen.

References

Iwasaki K, Matsuda H, Nagase K, Shiraga T, Tokuma Y, Uchida K "Effects of twenty-three drugs on the metabolism of FK506 by human liver microsomes." Res Commun Chem Pathol Pharmacol 82 (1993): 209-16
Bhaloo S, Prasad GV "Severe reduction in tacrolimus levels with rifampin despite multiple cytochrome P450 inhibitors: a case report." Transplant Proc 35 (2003): 2449-51
Furlan V, Perello L, Jacquemin E, Debray D, Taburet AM "Interactions between FK506 and rifampin or erythromycin in pediatric liver recipients." Transplantation 59 (1995): 1217-8
Moreno M, Latorre A, Manzanares C, et al "Clinical management of tacrolimus drug interactions in renal transplant patients." Transplant Proc 31 (1999): 2252-3
Chenhsu RY, Loong CC, Chou MH, Lin MF, Yang WC "Renal allograft dysfunction associated with rifampin-tacrolimus interaction." Ann Pharmacother 34 (2000): 27-31
Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
"Product Information. Prograf (tacrolimus)." Fujisawa, Deerfield, IL.
Thompson PA, Mosley CA "Tacrolimus-phenytoin interaction." Ann Pharmacother 30 (1996): 544
Hebert MF, Fisher RM, Marsh CL, Dressler D, Bekersky I "Effects of rifampin on tacrolimus pharmacokinetics in healthy volunteers." J Clin Pharmacol 39 (1999): 91-6
Cerner Multum, Inc. "Australian Product Information." O 0

Carbamazepine Extended-Release Capsules (Carbatrol)

Generic Name: carbamazepine

Brand name: Carbatrol, Epitol, Equetro, Tegretol, Tegretol XR, Tegretol, Tegretol XR

Synonyms: Carbamazepine, CarBAMazepine

What is Carbamazepine Extended-Release Capsules (Carbatrol)?

Tacrolimus Injection

Generic Name: tacrolimus

Brand name: Astagraf XL, Envarsus XR, Prograf, Hecoria

Synonyms: Tacrolimus (oral and injection), Tacrolimus (Systemic)

What is Tacrolimus Injection?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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