Mi-Acid Double Strength and Prograf (Tacrolimus Granules for Suspension)
Determining the interaction of Mi-Acid Double Strength and Prograf (Tacrolimus Granules for Suspension) and the possibility of their joint administration.
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 magnesium hydroxide together with tacrolimus can increase the effects of tacrolimus. Contact your doctor if you experience fever, infection, diarrhea, tremor, headache, fatigue, lethargy, and changes in motor function, mental status, or sensory function. You may need a dose adjustment or special test to safely use 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: Coadministration with aluminum-magnesium hydroxide may increase tacrolimus blood concentrations in vivo. The mechanism of interaction is unknown. In a single-dose study, administration of tacrolimus with aluminum-magnesium hydroxide in healthy volunteers resulted in a 10% and 21% increase in tacrolimus peak concentration (Cmax) and systemic exposure (AUC), respectively, compared to administration without aluminum-magnesium hydroxide. This finding contradicts the results from an in vitro study, which showed that tacrolimus incubated in 100 mL simulated gastric fluid with the equivalent of 500 mg of various antacids resulted in loss of tacrolimus, due presumably to a pH-mediated degradation of tacrolimus. Specifically, Mylanta caused a 14% loss of tacrolimus in 24 hours, magnesium oxide caused a 98% loss in 12 hours, and calcium carbonate caused a 30% loss in 24 hours. In contrast, aluminum hydroxide gel caused an immediate 35% loss of tacrolimus (within 2 minutes) and no further loss for 24 hours, suggesting adsorption of tacrolimus.
MANAGEMENT: Given the narrow therapeutic index and the large interindividual variability in the pharmacokinetics of tacrolimus, caution is advised if the drug is used in combination with aluminum and/or magnesium hydroxide. Pharmacologic response and tacrolimus blood levels should be monitored more closely whenever aluminum/magnesium hydroxide is added to or discontinued from therapy, and the immunosuppressant dosage adjusted as necessary. Patients should be advised to contact their doctor if they experience potential signs and symptoms of tacrolimus toxicity such as fever, infection, diarrhea, tremor, headache, fatigue, lethargy, and changes in motor function, mental status, or sensory function.
- Steeves M, Abdallah HY, Venkataramanan R, et al "In-vitro activation of a novel immunosuppressant, FK 506, and antacids." J Pharm Pharmacol 43 (1991): 574-7
- "Product Information. Prograf (tacrolimus)." Fujisawa, Deerfield, IL.
Generic Name: calcium carbonate / magnesium hydroxide
Brand name: Mi-Acid Double Strength, Mylanta Supreme, Rolaids, Fast Acting Mylanta, Mylanta Ultra, Mylanta Gelcap, Rolaids Extra Strength, Masanti Supreme
Synonyms: n.a.
Generic Name: tacrolimus
Brand name: Prograf, Astagraf XL, Envarsus XR, Hecoria
Synonyms: Prograf
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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