Prograf and Reglan

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.

Using tacrolimus together with metoclopramide may increase the effects of tacrolimus. Contact your doctor if you experience increased side effects such as fever, infection, diarrhea, tremor, headache, fatigue, or lethargy. If your doctor does prescribe these medications together, 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.

MONITOR: Coadministration with gastrointestinal prokinetic agents such as cisapride, domperidone, and metoclopramide may increase the oral bioavailability of macrolide immunosuppressants. Because macrolide immunosuppressants are incompletely and variably absorbed following oral administration, increased gastrointestinal motility and gastric emptying can enhance delivery of the drugs to the small intestine where they are absorbed. In one case report, a patient with signs and symptoms of acute graft rejection in association with persistent subtherapeutic tacrolimus trough concentrations despite coadministration with ketoconazole as a pharmacokinetic booster experienced tacrolimus toxicity following the addition of metoclopramide for nausea and vomiting. Tacrolimus trough concentration exceeded 30 ng/ml, and the patient exhibited signs and symptoms suggestive of tacrolimus neuro- and nephrotoxicity. The authors theorized that the patient's persistent subtherapeutic tacrolimus levels may have been secondary to impaired gastric motility, and improvement of the condition by metoclopramide may have led to subsequent tacrolimus toxicity.

MANAGEMENT: Pharmacologic response, renal function, and macrolide immunosuppressant blood levels should be monitored more closely whenever a gastrointestinal prokinetic agent is added to or discontinue from therapy, and the immunosuppressant dosage adjusted as necessary. Patients should be advised to contact their physician if they experience potential signs and symptoms of macrolide immunosuppressant toxicity such as fever, infection, diarrhea, tremor, headache, fatigue, or lethargy.

Prograf

Generic Name: tacrolimus

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

Synonyms: n.a.

What is Prograf?

Reglan

Generic Name: metoclopramide

Brand name: Reglan, Metozolv ODT

Synonyms: n.a.

What is Reglan?