Does Tacrolimus Interact with Azithromycin?
Tacrolimus and Azithromycin have a moderate drug interaction according to established clinical references. Azithromycin may increase tacrolimus blood concentrations, raising the risk of tacrolimus toxicity (nephrotoxicity, neurotoxicity); both drugs can also prolong the QT interval. Monitor tacrolimus levels and renal function when starting or stopping azithromycin. The mechanism involves azithromycin is a weak inhibitor of cyp3a4 and p-glycoprotein, reducing tacrolimus clearance; additive qt-interval prolongation also applies. Patients taking both medications should consult their healthcare provider before starting, stopping, or changing the dosage of either drug. This information is drawn from established clinical references and is provided alongside our FDA-labeling–based data.
- Severity
- Moderate
- Tacrolimus Class
- Calcineurin Inhibitor Immunosuppressant
- Management
- Monitor for effects
- Data Source
- Curated clinical reference
How This Interaction Works
The interaction between Tacrolimus and Azithromycin occurs because azithromycin is a weak inhibitor of cyp3a4 and p-glycoprotein, reducing tacrolimus clearance; additive qt-interval prolongation also applies. Clinically, this means azithromycin may increase tacrolimus blood concentrations, raising the risk of tacrolimus toxicity (nephrotoxicity, neurotoxicity); both drugs can also prolong the qt interval. monitor tacrolimus levels and renal function when starting or stopping azithromycin. This is classified as a moderate interaction. While it may not require stopping either medication, your healthcare provider should be aware you are taking both so they can monitor for potential effects and adjust treatment if necessary.
What To Tell Your Doctor or Pharmacist
If you are taking Tacrolimus and your doctor is considering prescribing Azithromycin (or vice versa), make sure to:
- Inform your doctor and pharmacist of all current medications, including over-the-counter drugs and supplements
- Ask whether the benefits of combining these medications outweigh the risks for your specific situation
- Ask what symptoms to watch for that would indicate the interaction is causing problems
- Ask whether any dosage adjustments are needed
- Never stop or change either medication without first consulting your healthcare provider