tacrolimus and diltiazem

MajorAvoid this combination where possible.

Mechanism

Diltiazem inhibits CYP3A4, the principal enzyme responsible for tacrolimus metabolism, leading to increased tacrolimus plasma concentrations.

What it means clinically

Tacrolimus toxicity may occur, including nephrotoxicity, neurotoxicity, and infections. Symptoms may include elevated serum creatinine, tremors, and headache.

What to do

Avoid co-prescription if possible. If necessary, reduce tacrolimus dose and monitor blood levels frequently, adjusting dose based on concentrations.

Evidence

This interaction is well established in clinical practice and supported by pharmacokinetic studies and case reports.

The two drugs

tacrolimuscalcineurin inhibitorRead the monograph diltiazemCalcium channel blockersRead the monograph

Practise prescribing around interactions like this one

Oskela marks prescriptions against this interaction database automatically: write a chart for a simulated patient and every clash is caught and explained.

Try a prescription, no account Create a free account

Other interactions involving tacrolimus or diltiazem

Educational reference for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.