Rabeprazole Tacrolimus

Clinically important, potentially hazardous interactions with amiodarone, atazanavir, azithromycin, bosentan, ciprofibrate, clarithromycin, clopidogrel, cyclosporine, darunavir, delavirdine, diltiazem, erythromycin, fosamprenavir, fusidic acid, gemfibrozil, grapefruit juice, imatinib, itraconazole, lopinavir, rabeprazole, ranolazine, red rice yeast, ritonavir, roxithromycin, selenium, St John s wort, tacrolimus, telithromycin, tipranavir, verapamil, warfarin... 

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. 

Another report describes a patient who had no significant alteration in tacrolimus levels when rabeprazole 10 mg daily was started and stopped. ... 

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. 

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