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Phenytoin Sodium and Tacrolimus Capsules

Determining the interaction of Phenytoin Sodium and Tacrolimus Capsules and the possibility of their joint administration.

Check result:

Phenytoin Sodium <> Tacrolimus Capsules

Relevance: 26.07.2022 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:

Phenytoin may reduce the blood levels and effects of tacrolimus and in addition, tacrolimus may increase the blood levels and effects of phenytoin. Contact your doctor if your symptoms worsen or your condition changes during treatment with these medications. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring 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 CLOSELY: Coadministration with potent inducers of CYP450 3A4, such as phenytoin, may decrease the plasma concentrations of tacrolimus, which is primarily metabolized by the isoenzyme. In a case report, two Japanese heart transplant patients required 2 to 3-fold increases in their tacrolimus doses to maintain the required tacrolimus blood level when used concomitantly with phenytoin. In other case reports, phenytoin has been used to increase tacrolimus metabolism and elimination, thereby reducing the risk of tacrolimus toxicity. Conversely, concomitant use of phenytoin and tacrolimus may also result in increased plasma concentrations of phenytoin, but the mechanism of this effect has not been established.

MANAGEMENT: Given the risk of organ rejection associated with inadequate immunosuppressant drug levels, caution is advised during concomitant therapy with CYP450 3A4 inducers. Tacrolimus blood levels should be checked frequently and the dosage adjusted accordingly whenever a CYP450 3A4 inducer is added to or withdrawn from therapy. In addition, serum phenytoin levels should be monitored more closely and the dosage adjusted as necessary whenever tacrolimus is added to or withdrawn from therapy.

References

El-Asmar J, Gonzalez R, Bookout R, Mishra A, Kharfan-Dabaja MA "Clotrimazole troches induce supratherapeutic blood levels of sirolimus and tacrolimus in an allogeneic hematopoietic cell-transplant recipient resulting in acute kidney injury." Hematol Oncol Stem Cell Ther (2015):
Thompson PA, Mosley CA "Tacrolimus-phenytoin interaction." Ann Pharmacother 30 (1996): 544
Patel SJ, Kuten SA, Musick WL, Gaber AO, Monsour HP, Knight RJ "Combination drug products for HIV - a word of caution for the transplant clinician." Am J Transplant (2016):
Cerner Multum, Inc. "Australian Product Information." O 0
Wada K, Takada M, Ueda T, et al. "Drug interactions between tacrolimus and phenytoin in Japanese heart transplant recipients: 2 case reports." Int J Clin Pharmacol Ther 45 (2007): 524-8
"Product Information. Prograf (tacrolimus)." Fujisawa, Deerfield, IL.
Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

Phenytoin Sodium

Generic Name: phenytoin

Brand name: Dilantin, Dilantin Infatabs, Phenytek, Phenytoin Sodium, Prompt

Synonyms: n.a.

What is Phenytoin Sodium?

Tacrolimus Capsules

Generic Name: tacrolimus

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

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

What is Tacrolimus Capsules?

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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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