Macrolide and Tacrolimus: Drug Interaction Guide
Quick answer: This is a major interaction — avoid combining Macrolide and Tacrolimus unless specifically directed by your doctor.
How Macrolide interacts with Tacrolimus
Macrolides (erythromycin, clarithromycin) inhibit CYP3A4 and P-glycoprotein, the principal pathways for tacrolimus metabolism and efflux, causing marked rises in trough levels.
What you should do
Prefer azithromycin where antibiotic needed. If erythromycin or clarithromycin essential, reduce tacrolimus dose by ~50% and monitor trough levels every 2-3 days.
Key facts
Severity
Major — avoid combination
Mechanism
Macrolides (erythromycin, clarithromycin) inhibit CYP3A4 and P-glycoprotein, the principal pathways for tacrolimus metab...
Action
Prefer azithromycin where antibiotic needed. If erythromycin or clarithromycin essential, reduce tacrolimus dose by ~50%...
Frequently asked questions
Can I take Macrolide and Tacrolimus together?
No — this combination should generally be avoided. Prefer azithromycin where antibiotic needed. If erythromycin or clarithromycin essential, reduce tacrolimus dose by ~50% and monitor trough levels every 2-3 days.
What is the severity of this interaction?
The interaction between Macrolide and Tacrolimus is classified as Major — avoid combination. Macrolides (erythromycin, clarithromycin) inhibit CYP3A4 and P-glycoprotein, the principal pathways for tacrolimus metabolism and efflux, causing marked rises in trough levels.
What should I do if I'm prescribed both?
Prefer azithromycin where antibiotic needed. If erythromycin or clarithromycin essential, reduce tacrolimus dose by ~50% 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.