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fluconazole in dextrose (iso-osmotic) intravenous

Tacrolimus; Temsirolimus/Azole Antifungals (mono deleted 10/24/2013)

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:

The antifungal agent may increase the amount of tacrolimus or temsirolimus absorbs and it may decrease your body's ability to process tacrolimus or temsirolimus.

What might happen:

The levels of tacrolimus or temsirolimus in your blood may increase and damage your kidneys.

What you should do about this interaction:

Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking both of these medications. The amount of tacrolimus or temsirolimus in your blood may need to checked more frequently while taking these medications together. Your doctor may want to change the dose of your medicine.Your healthcare professionals 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:

1.Noxafil (posaconazole) UK summary of product characteristics. Schering-Plough Ltd. February 2, 2006.
2.Noxafil (posaconazole) US prescribing information. Schering Corporation June, 2012.
3.Vfend (voriconazole) US prescribing information. Pfizer Inc. November, 2011.
4.Torisel (temsirolimus) US prescribing information. Wyeth Pharmaceuticals, Inc. June, 2011.
5.Manez R, Martin M, Raman D, Silverman D, Jain A, Warty V, Gonzalez-Pinto I, Kusne S, Starzl TE. Fluconazole therapy in transplant recipients receiving FK506. Transplantation 1994 May 27;57(10):1521-3.
6.Osowski CL, Dix SP, Lin LS, Mullins RE, Geller RB, Wingard JR. Evaluation of the drug interaction between intravenous high-dose fluconazole and cyclosporine or tacrolimus in bone marrow transplant patients. Transplantation 1996 Apr 27;61(8):1268-72.
7.Capone D, Gentile A, Imperatore P, Palmiero G, Basile V. Effects of itraconazole on tacrolimus blood concentrations in a renal transplant recipient. Ann Pharmacother 1999 Oct;33(10):1124-5.
8.Billaud EM, Guillemain R, Tacco F, Chevalier P. Evidence for a pharmacokinetic interaction between itraconazole and tacrolimus in organ transplant patients. Br J Clin Pharmacol 1998 Sep;46(3):271-2.
9.Furlan V, Parquin F, Penaud JF, Cerrina J, Ladurie FL, Dartevelle P, Taburet AM. Interaction between tacrolimus and itraconazole in a heart-lung transplant recipient. Transplant Proc 1998 Feb;30(1):187-8.
10.Kramer MR, Merin G, Rudis E, Bar I, Nesher T, Bublil M, Milgalter E. Dose adjustment and cost of itraconazole prophylaxis in lung transplant recipients receiving cyclosporine and tacrolimus (FK 506). Transplant Proc 1997 Sep;29(6):2657-9.
11.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.
12.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.
13.Prograf (tacrolimus) US prescribing information. Fujisawa Healthcare, Inc. September, 2013.
14.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.
15.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.
16.Sansone-Parsons A, Krishna G, Martinho M, Kantesaria B, Gelone S, Mant TG. Effect of oral posaconazole on the pharmacokinetics of cyclosporine and tacrolimus. Pharmacotherapy 2007 Jun;27(6):825-34.
17.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.
18.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.
19.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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