Lansoprazole Tacrolimus

Transporter efflux transporter effects predominant Examples Amiodarone Atorvastatin Azithromycin Carbamazepine Carvediioi Chlorpromazine Ciprofloxacin Cisapride Cyciosporine Danazoi Dapsone Diclofenac Diflunisal Digoxin Erythromycin Flurbiprofen Glipizide Glyburide Griseofulvin Ibuprofen Indinavir Indomethacin Itraconazole Ketoconazole Lansoprazole Lovastatin Mebendazole Naproxen Nelfinavir Ofloxacin Oxaprozin Phenazopyridine Phenytoin Piroxicam Raloxifene Ritonavir Saquinavir Saquinavir Sirolimus Sirolimus Spironolactone Spironolactone Tacrolimus Tacrolimus ... 

Acetaminophen, aldrin, alfentanil, amiodarone, aminopyrine, amitriptyline, amprenavir, androstenedione,antipyrine, astemizole, benzphetamine, budesonide, carbamazepine, celecoxib, chlorpromazine, chlorzoxazone, cisapride, clarithromycin, clozapine, cocaine, codeine, cortisol, cyclophosphamide,cyclosporin, dapsone, delavirdine, dextromethorphan, digitoxin, diltiazem, diazepam, erythromycin, 17j3-estradiol, ethinylestradiol, etoposide, felbamate, fentanyl, flutamide, hydroxyarginine, ifosphamide, imipramine, indinavir, ketoconazole, lansoprazole, loratidine, losartan, lovastatin, (iS)"mephen3d in, methadone, mianserin, miconazole, mifepristone, nelfinavir, nevirapine, nicardipine, nifedipine, odansetron, omeprazole, orphenadrine, proguanil, propafenone, quinidine, quinine, rapamycin, retinoic acid, ritonavir, saquinavir, selegiline, serindole, sufentanil, sulfinpyrazone, tacrolimus, tamoxifen, tamsulosin, taxol, teniposide, terfenadine, tetrahydrocannabinol, theophylline, toremifene, triazolam, trimethadone, trimethoprim, troleandomycin, verapamil, warfarin, zatosetron, Zolpidem, zonisamide... 

Imatinib increases serum tacrolimus levels and is therefore predicted to increase ciclosporin levels. Imatinib may also increases the levels of some benzodiazepines (e.g. midazolam), some calcium-channel blockers (e.g. nifedipine), oestrogens, paracetamol, pimozide, and warfarin. In one case lansoprazole was suspected to have raised imatinib levels. 

Lansoprazole may increase tacrolimus levels in patients with low levels of the cytochrome P4S0 isoenzyme CYP2C19. Pantoprazole and omeprazole are predicted to interact similarly. Rabeprazole appears not to interact with tacrolimus. 

The incidence of the interaction between tacrolimus and lansoprazole is unknown. It would seem to most frequently occur in those with decreased CYP2C19 activity, and therefore it is not easy to predict which patients would be affected. The manufacturers of tacrolimus say that this interaction may also occur with omeprazole, which is metabolised in the same way as lansoprazole. It would seem prudent to monitor tacrolimus levels if either of these proton pump inhibitors is started or stopped. Although no interaction was noted in the study with pantoprazole the authors do note that it may interact like lansoprazole in patients with CYP2C19 deficiency. Rabeprazole may be a suitable alternative proton pump inhibitor as limited evidence suggests that it does not interact, and nor would it be expected to do so. 

Homma M, Itagaki F, Yuzawa K, Fukao K, Kohda Y. Effects of lansoprazole and rabeprazole on tacrolimus Blood concentration case of a renal transplant recipient with CYP2C19 gene mutation. Transplantation (2002) 73, 303-4. 

FracaroH TS, Miranda LQ, Sodre JL, Chaves M, Gripp A. Toxic epidermal necrolysis induced by lansoprazole. An Bras Dermatol 2013 88 117-20. Zhao W, Fakhoury M, Maisin A, Baudouin V, Storme T, Deschenes G, et al. Pharmacogenetic determinant of the drug interaction between tacrolimus and omeprazole. Ther DrugMonit 2012 34 739-A1. 

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