Sertraline Tacrolimus

Prednisolone Progesterone Protease Inlaibitors Quinidine (1 )-Warfarin Rifampin Sertraline Sirolimus Simvastatin Tacrolimus Testosterone Trazadone Triazolam Voriconazole ... 

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. 

A kidney transplant patient taking prednisone, azathioprine and tacrolimus 5 mg daily for 2 years experienced headache, confusion and grey areas in her vision within one week of starting nefazodone 50 mg twice daily in place of sertraline, for depression. Her serum creatinine had risen from 132 to 195 micromol/Land her trough tacrolimus level was greater than 30 nanograms/niL. Nefazodone was replaced by sertraline, and tacrolimus was withheld for 4 days. Signs oftacrolimus-induced neurotoxicity disappeared within 36 hours and serum creatinine and tacrolimus levels returned to pretreatment levels within 2 weeks. ... 

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. 

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