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Nizoral oral

Selected Immunosuppressants/Azole Antifungal Agents

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Antifungal medicines may may slow down how quickly your body processes cyclosporine, sirolimus, tacrolimus, and temsirolimus.

What might happen:

Your blood levels of cyclosporine, sirolimus, tacrolimus, or temsirolimus may increase and cause toxic effects that may harm your kidneys.

What you should do about this interaction:

Make sure that your doctor knows all of the medicines that you are taking.Tell your doctor if you have any kidney problems. If you experience any shortness of breath, unusual swelling, changes in the color or amount of your urine, or changes in how often you urinate, contact your doctor.The amount of cyclosporine, sirolimus, tacrolimus, or temsirolimus in your blood may need to be checked more often and the dosage adjusted when you first start or stop taking the antifungal medicine.Your healthcare professionals (e.g. doctor or pharmacist) may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

References:

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36.Katari SR, Magnone M, Shapiro R, Jordan M, Scantlebury V, Vivas C, Gritsch A, McCauley J, Starzl T, Demetris AJ, Randhawa PS. Clinical features of acute reversible tacrolimus (FK 506) nephrotoxicity in kidney transplant recipients. Clin Transplant 1997 Jun;11(3):237-42.
37.Floren LC, Bekersky I, Benet LZ, Mekki Q, Dressler D, Lee JW, Roberts JP, Hebert MF. Tacrolimus oral bioavailability doubles with coadministration of ketoconazole. Clin Pharmacol Ther 1997 Jul;62(1):41-9.
38.Prograf (tacrolimus) US prescribing information. Fujisawa Healthcare, Inc. September, 2013.
39.Assan R, Fredj G, Larger E, Feutren G, Bismuth H. FK 506/fluconazole interaction enhances FK 506 nephrotoxicity. Diabete Metab 1994 Jan-Feb; 20(1):49-52.
40.Mieles L, Venkataramanan R, Yokoyama I, Warty VJ, Starzl TE. Interaction between FK506 and clotrimazole in a liver transplant recipient. Transplantation 1991 Dec;52(6):1086-7.
41.Capone D, Tarantino G, Gentile A, Sabbatini M, Polichetti G, Santangelo M, Nappi R, Ciotola A, D'Alessandro V, Renda A, Basile V, Federico S. Effects of voriconazole on tacrolimus metabolism in a kidney transplant recipient. J Clin Pharm Ther 2010 Feb;35(1):121-4.
42.Kramer MR, Amital A, Fuks L, Shitrit D. Voriconazole and itraconazole in lung transplant recipients receiving tacrolimus (FK 506): efficacy and drug interaction. Clin Transplant 2010 Dec 16.
43.Mori T, Aisa Y, Kato J, Nakamura Y, Ikeda Y, Okamoto S. Drug interaction between voriconazole and calcineurin inhibitors in allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transplant 2009 Sep;44(6):371-4.

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