Omeprazole Tacrolimus

Drugs that may affect tacrolimus include nephrotoxic agents (aminoglycosides, amphotericin B, cisplatin, cyclosporine), antifungals, bromocriptine, calcium channel blockers, cimetidine, clarithromycin, danazol, diltiazem, erythromycin, methylprednisolone, metoclopramide, carbamazepine, phenobarbital, phenytoin, rifamycins, cisapride, chloramphenicol, metronidazole, nefazodone, omeprazole, protease inhibitors, macrolide antibiotics, fosphenytoin, and St. John s wort. 

Pascual J, Marcen R, Orea OE, et al. Interaction between omeprazole and tacrolimus in renal allograft recipients a clinical-analytical study. Transplant Proc 2005 37(9) 3752-3. 

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... 

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. 

A study in 51 kidney transplant patients taking tacrolimus and omeprazole 20 mg daily found no significant interaction. A retrospective study in 48 kidney transplant patients found that when patients switched from cimetidine 400 mg daily to omeprazole 20 mg daily resulted in a 15% decrease in the dose/weight normalised tacrolimus trough levels. ... 

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. 

Fexofenadine Imatinib Irinotecan Loperamide Methadone Midazolam Nefazodone Nevirapine Omeprazole Paroxetine oral contraceptives Phenprocoumon Setraline Simvastine Tacrolimus Theophylline Tolbutamide Voriconazole Warfarin... 

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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