Due to potential additive or synergistic impairment for renal function, care should be taken when administering Seegraf with drugs that may be associated with renal dysfunction. These include, but are not limited to, aminoglycosides, amphotericin B and cisplatin. Initial clinical experience with the co-administration of Seegraf and cyclosporine resulted in additive/synergistic nephrotoxicity. Patients switched from cyclosporine to Seegraf should receive the first Seegraf dose no sooner than 24 hrs after the last cyclosporine dose. Dosing may be delayed further in the presence of elevated cyclosporine levels. Since Seegraf is metabolized mainly by the CYP3A enzyme systems, substances known to inhibit these enzymes may decrease the metabolism of Seegraf with resultant increases in whole blood or plasma concentrations. Drugs known to increase to induce this enzyme systems may result in an increased metabolism of Seegraf and decreased whole blood or plasma concentrations. Monitoring of blood concentrations and appropriate dosage adjustments are essential when such drugs are used concomitantly.
Immunosuppressants may affect vaccination. Therefore, during treatment with Seegraf, vaccination may be less effective.
Reported drug interactions are as follows: Drugs that can Increase Seegraf Levels: Calcium-channel blockers, diltiazem, nicardipine, nifedipine, verapamil.
Antifungal Agents: Clotrimazole, fluconazole, itraconazole, ketoconazole.
Macrolide Antibiotics: Clarithromycin, erythromycin, troleandomycin.
Gastrointestinal Prokinetic Agents: Cisapride, metoclopramide.
Other Drugs: Bromocriptine, cimetidine, cyclosporine, danazol, ethinyl estradiol, methylprednisolone, omeprazole, protease inhibitors, nefazodone.
Drugs that can Reduce Seegraf Levels: Anticonvulsants: Carbamazepine, phenobarbital, phenytoin.
Antibiotics: Rifabutin, rifampin.
Herbal Preparation: St. John's wort.