Clarithromycin and Tacrolimus: Drug Interaction Guide
Quick answer: This is a major interaction — avoid combining Clarithromycin and Tacrolimus unless specifically directed by your doctor.
How Clarithromycin interacts with Tacrolimus
Clarithromycin strongly inhibits intestinal and hepatic CYP3A4 metabolism of tacrolimus, causing rapid 2-5 fold increases in tacrolimus blood levels with risk of nephrotoxicity and neurotoxicity.
What you should do
Substitute azithromycin where possible; if clarithromycin is required, reduce tacrolimus dose empirically by 50-66% and monitor trough levels every 2-3 days.
Key facts
Severity
Major — avoid combination
Mechanism
Clarithromycin strongly inhibits intestinal and hepatic CYP3A4 metabolism of tacrolimus, causing rapid 2-5 fold increase...
Action
Substitute azithromycin where possible; if clarithromycin is required, reduce tacrolimus dose empirically by 50-66% and ...
Frequently asked questions
Can I take Clarithromycin and Tacrolimus together?
No — this combination should generally be avoided. Substitute azithromycin where possible; if clarithromycin is required, reduce tacrolimus dose empirically by 50-66% and monitor trough levels every 2-3 days.
What is the severity of this interaction?
The interaction between Clarithromycin and Tacrolimus is classified as Major — avoid combination. Clarithromycin strongly inhibits intestinal and hepatic CYP3A4 metabolism of tacrolimus, causing rapid 2-5 fold increases in tacrolimus blood levels with risk of nephrotoxicity and neurotoxicity.
What should I do if I'm prescribed both?
Substitute azithromycin where possible; if clarithromycin is required, reduce tacrolimus dose empirically by 50-66% and monitor trough levels every 2-3 days. Always consult your prescribing clinician — do not stop or change medications without medical guidance.
Last reviewed: by iMedic Medical Editorial Team. Our editorial process.