Tacrolimus Extended-Release Capsules and Zithromax Tri-Pak

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 azithromycin together with tacrolimus can increase the risk of an irregular heart rhythm that may be serious. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or fast or pounding heartbeats during treatment with these 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: Both azithromycin and tacrolimus have rarely been associated with QT interval prolongation. Theoretically, concomitant use may result in additive effects and increased risk of ventricular arrhythmias including torsade de pointes and sudden death. In general, the risk of an individual agent or a combination of these agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s).

MONITOR: Rarely, azithromycin has been reported to increase the plasma concentrations of tacrolimus. The exact mechanism has not been established, since azithromycin is not generally considered an inhibitor of CYP450 3A4 or P-glycoprotein, of which tacrolimus is a substrate. Supportive evidence is limited to two published case reports. In one report, a patient receiving intravenous tacrolimus had a twofold increase in his tacrolimus levels three days after the initiation of azithromycin 500 mg/day. In the other report, a heart transplant patient had increased tacrolimus blood levels following the administration of intravenous azithromycin and ceftriaxone. Tacrolimus levels decreased after the discontinuation of ceftriaxone and switch from intravenous to oral azithromycin. In contrast, a 10-day course of azithromycin reportedly had no significant effect on serum creatinine or tacrolimus levels in a bone marrow transplant patient treated with tacrolimus.

MANAGEMENT: Caution and clinical monitoring are recommended when azithromycin and tacrolimus are prescribed in combination. Patients should be advised to seek medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitations, irregular heartbeat, shortness of breath, or syncope. It may be appropriate to monitor tacrolimus levels more closely following the initiation or discontinuation of azithromycin.

Tacrolimus Extended-Release Capsules

Generic Name: tacrolimus

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

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

What is Tacrolimus Extended-Release Capsules?

Zithromax Tri-Pak

Generic Name: azithromycin

Brand name: Zithromax, Zmax, AzaSite, Azithromycin 3 Day Dose Pack, Azithromycin 5 Day Dose Pack, Zithromax Tri-Pak, Zithromax Z-Pak, Zithromax IV

Synonyms: Zithromax

What is Zithromax Tri-Pak?