Increased tacrolimus blood levels w/ CYP3A4 inhibitors: antifungal agents eg, ketoconazole, fluconazole, itraconazole, voriconazole, isavuconazole; erythromycin; HIV PIs eg, ritonavir, nelfinavir, saquinavir, HCV PIs eg, telaprevir, boceprevir; & the combination of ombitasvir & paritaprevir w/ ritonavir, when used w/ or w/o dasabuvir; letermovir; cobicistat; tyrosine kinase inhibitors nilotinib & imatinib; clotrimazole, clarithromycin, josamycin, nifedipine, nicardipine, diltiazem, verapamil, amiodarone, danazol, ethinylestradiol, omeprazole, nefazodone, herbal remedies containing extr of Schisandra sphenanthera
; bromocriptine, cortisone, dapsone, ergotamine, gestodene, lidocaine, mephenytoin, miconazole, midazolam, nilvadipine, norethisterone, quinidine, tamoxifen, troleandomycin; grapefruit juice; lansoprazole, ciclosporin. Increased tacrolimus blood levels w/ other active substances known to have high affinity for plasma proteins (eg, NSAIDs, oral anticoagulants, oral antidiabetics); prokinetic agents (eg, metoclopramide); cimetidine; Mg-Al hydroxide. Decreased tacrolimus blood levels w/ rifampicin, phenytoin, St. John's wort; phenobarb; maintenance doses of corticosteroids; carbamazepine, metamizole, INH. Increased or decreased tacrolimus blood levels w/ high dose prednisolone or methylprednisolone. May affect metabolism of CYP3A4 substrates. Prolonged t½
of ciclosporin. Synergistic/additive nephrotoxic effects w/ ciclosporin. Increased blood levels of phenytoin. Reduced clearance of steroid-based contraceptives. Changes in mycophenolic acid exposures when switching combination therapy from ciclosporin to tacrolimus. Increased toxic effects w/ medicinal products known to have nephrotoxic or neurotoxic effects (eg, aminoglycosides, gyrase inhibitors, vancomycin, sulfamethoxazole + trimethoprim, NSAIDs, ganciclovir or acyclovir). Enhanced nephrotoxicity w/ amphotericin B & ibuprofen. Increased risk of hyperkalaemia w/ high K intake or K-sparing diuretics (eg, amiloride, triamterene, spironolactone). Immunosuppressants may affect the response to vaccination & vaccination during treatment w/ tacrolimus may be less effective.