MAJOR — Use With Caution
🔴 AVOID — FDA-documented interaction. Clarithromycin strongly inhibits CYP3A4/P-gp, significantly increasing tacrolimus levels. Dose reduction and level monitoring essential. Consider azithromycin.
Evidence level: STRONG
Clarithromycin can dramatically increase tacrolimus levels, potentially causing kidney damage and other toxic effects. Transplant patients must have their tacrolimus levels closely monitored.
Clarithromycin is a strong CYP3A4 and P-gp inhibitor. Tacrolimus is a CYP3A4 and P-gp substrate. Significant increase in tacrolimus levels. FDA tacrolimus label warns about macrolide antibiotics.
Your transplant team should be notified before you start any macrolide antibiotic. Tacrolimus dose adjustment will likely be needed.
Follow each medication's specific timing instructions. Clarithromycin — check if it requires an empty stomach or should be taken with food. Tacrolimus follows its normal schedule. Complete the full antibiotic course as prescribed.
Higher risk for: those with liver or renal impairment, elderly, concurrent use of nephrotoxic or hepatotoxic drugs, history of C. difficile infection, or those on narrow therapeutic index medications (warfarin, digoxin).
Tremor, headache, decreased urination, swelling, nausea, kidney pain, confusion, high blood sugar
Notify transplant team. Request tacrolimus level and renal function monitoring. Consider azithromycin instead.
Antibiotic interactions are often temporary (duration of treatment). Space supplements and probiotics 2-3 hours away from antibiotic doses. Ask your pharmacist if timing adjustments can reduce the interaction risk.
Clarithromycin can dramatically increase tacrolimus levels, potentially causing kidney damage and other toxic effects. Transplant patients must have their tacrolimus levels closely monitored.
Follow each medication's specific timing instructions. Clarithromycin — check if it requires an empty stomach or should be taken with food. Tacrolimus follows its normal schedule. Complete the full antibiotic course as prescribed.
Tremor, headache, decreased urination, swelling, nausea, kidney pain, confusion, high blood sugar
Antibiotic interactions are often temporary (duration of treatment). Space supplements and probiotics 2-3 hours away from antibiotic doses. Ask your pharmacist if timing adjustments can reduce the interaction risk.
Notify transplant team. Request tacrolimus level and renal function monitoring. Consider azithromycin instead.
Or browse the full interaction database (121,000+ pairs).