Paroxetine Tacrolimus

CHjNaO 124-41-4) see Atorvastatin calcium Brinzolamide Ciprofloxacin Cisapride Dextrothyroxine Epirizole Hydroxyprogesterone Metaclazepam Moxifloxacin hydrochloride Moxonidine Oxcarbazepine Pantoprazole sodium Sulfadimethoxine Sulfalene Sulfamcthoxypyridazine Tacrolimus Vincamine sodium 3,4-(methylenedioxy)phenolate (CjHjNaOj 57f74-0i-5) sec Paroxetine sodium 4-nitrophenolate... 

Campo JV, Smith C, Perel JM. Tacrolimus toxic reaction associated with the use of nefazodone paroxetine as an alternative agent. Arch Gen Psychiatry 1998 55(ll) 1050-2. 

Clinically important, potentially hazardous interactions with alfentanil, aminophylline, amisulpride, amoxicillin, ampicillin, anticonvulsants, astemizole, atorvastatin, benzodiazepines, bromocriptine, buprenorphine, bupropion, carbamazepine, cilostazol, ciprofloxacin, cisapride, clindamycin, colchicine, cyclosporine, dasatinib, digoxin, dihydroergotamine, diltiazem, disopyramide, enoxacin, eplerenone, ergotamine, eszopiclone, everolimus, fluconazole, fluoxetine, fluvastatin, gatifloxacin, HMG-CoA reductase inhibitors, imatinib, itraconazole, ketoconazole, lomefloxacin, lorazepam, lovastatin, methadone, methylprednisolone, methysergide, midazolam, mizolastine, moxifloxacin, nitrazepam, norfloxacin, ofloxacin, paroxetine, pimozide, pravastatin, quinolones, ranolazine, repaglinide, rupatadine, sertraline, sildenafil, simvastatin, sparfloxacin, sulpiride, tacrolimus, terfenadine, triazolam, troleandomycin, vardenafil, verapamil, vinblastine, warfarin, zaleplon, zolpidem, zuclopenthixol... 

Marked increases in tacrolimus levels and toxicity were observed when three patients were also given nefazodone. In theory, flu-voxamine may increase tacrolimus levels. Paroxetine and sertraline may not interact, but the situation is not clear. 

Tacrolimus is metabolised by the cytochrome P450 isoenzyme CYP3A4, which is inhibited by nefazodone, concurrent use therefore results in increased levels of tacrolimus. Paroxetine and sertraline do not have significant effects on CYP3A4 and are therefore not expected to interact with tacrolimus. 

Fluvoxamine is an inhibitor of CYP3A4 and so theoretically could affect the metabolism of tacrolimus. Close monitoring of tacrolimus levels is therefore advised. Paroxetine and sertraline and possibly other SSRIs may be suitable alternative antidepressants, but the evidence is slim, so additional monitoring may still be warranted. Further study on the use of antidepressants with tacrolimus is needed. 

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

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