AZOLES AND TACROLIMUS

When tacrolimus is given orally, its serum levels are considerably increased (within 3 days) by oral fluconazole. In vitro study suggests miconazole may interact similarly. Itraconazole, ketoconazole, posaconazole, voriconazole, and possibly oral clotrima- zole or miconazole oral gel, also raise tacrolimus levels. There is some evidence that the levels of intravenous tacrolimus are minimally affected by fluconazole and ketoconazole.
One study specifically examining dose adjustments suggests that fluconazole can be safely used if 60% of the original tacrolimus dose is given. Nearly all patients are expected to need dose reductions if azoles are given: the manufacturers of posaconazole and voriconazole suggest a reduction of two-thirds. Monitor tacrolimus levels closely if any azole is given.