From the Guidelines
Azithromycin can be used with Prograf (tacrolimus) and CellCept (mycophenolate mofetil), but careful monitoring is necessary due to potential drug interactions, particularly with tacrolimus, as azithromycin may increase its concentrations by inhibiting the P-gp efflux protein, as noted in a 2020 study 1. When taking azithromycin alongside these immunosuppressants, tacrolimus levels should be monitored closely to avoid potential toxicity, which could lead to kidney problems, tremors, headaches, or high blood pressure. Some key points to consider when using azithromycin with Prograf and CellCept include:
- Monitoring tacrolimus levels closely, as azithromycin may increase its concentrations, potentially leading to toxicity 1
- Informing the transplant team before starting azithromycin, to ensure close monitoring of tacrolimus levels
- Checking tacrolimus levels within 3-5 days of starting the antibiotic, to quickly identify any potential issues
- Being aware of the typical azithromycin dosing for infections, which is 500mg on day one followed by 250mg daily for 4 more days, though this may vary based on the specific infection being treated
- Reporting any unusual symptoms like increased tremors, decreased urination, or extreme fatigue while taking this combination of medications. It's also important to note that the use of generic immunosuppressive therapy, such as generic formulations of CNIs and antimetabolites, should be done with caution, as there may be concerns about bioequivalence and therapeutic drug monitoring, as discussed in a 2016 study 1.
From the Research
Azithromycin Use with Prograf and Cellcept
- There is no direct evidence in the provided studies regarding the use of azithromycin with Prograf (tacrolimus) and Cellcept (mycophenolate mofetil) 2, 3, 4, 5, 6.
- However, the studies discuss the use of immunosuppressive drugs, including tacrolimus and mycophenolate mofetil, in various contexts, such as preventing graft-versus-host disease and treating immune-related adverse events 3, 6.
- The use of azithromycin, an antibiotic, may be relevant in the context of preventing infections in patients taking immunosuppressive drugs, as infections are a common adverse effect of immunosuppression 4, 5.
- A study on the safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression found that the combination was superior in preventing acute cellular rejection, but showed no difference in the risk of adverse events compared to other immunosuppressive regimens 6.
- Another study found that patients treated for immune-related adverse events with immunosuppressants, including steroids and infliximab, had a high incidence of infectious adverse events, highlighting the need for careful management of infections in patients taking immunosuppressive drugs 5.