Clinical experience in the treatment of overdose – is limited. Several cases of accidental overdose of the drug, with the following symptoms: tremor, headache, nausea, vomiting, infections, urticaria, lethargy, increased blood urea nitrogen level and an increase in serum creatinine concentrations, and increase in alanine aminotransferase levels.
The specific antidote to absent. If developed overdosing is necessary to take the standard measures and conduct edema symptomatic treatment.
In this regard, high molecular weight, poor water solubility and binding to red blood cells and plasma proteins is largely expected that the dialysis is not efficient in overdose of tacrolimus. For some patients with very high levels of drug in plasma diafiltration and hemofiltration blood proved to be effective, lowering toxic concentration of the drug. In the cases of toxicity after oral administration of the drug can help gastric lavage and / or reception of adsorbent (such as activated carbon).
Interaction with other drugs
Tacrolimus testosterone suspension reviews is largely metabolized by hepatic microsomal cytochrome P-4503A4 isoenzymes . Concomitant use of drugs or herbal medicines that inhibit or induce the CYP3A4, could affect the metabolism of tacrolimus and thereby increase or decrease tacrolimus levels in the blood.
Tacrolimus has also broad and powerful effect on dependent metabolism; thus concomitant use of tacrolimus with drugs that are metabolized by dependent pathways may affect the metabolism of these drugs (eg, cortisone, testosterone).
Tacrolimus is largely bound to plasma proteins. It should take into account possible interactions with other drugs which have a high affinity to blood proteins (e.g., NSAIDs, oral anticoagulants, or oral antidiabetic drugs).
Concomitant use of tacrolimus with drugs possessing nephrotoxic or neurotoxic effects may increase the toxicity level (e.g., aminoglycosides, inhibitors of gyrase (DNA topoisomerase II type), vancomycin, trimethoprim-sulfamethoxazole, NSAIDs, ganciclovir or acyclovir).
Since treatment with tacrolimus can be accompanied by the development of hyperkalemia, or may enhance pre-existing hyperkalemia, should be avoided:
- Excessive intake of potassium testosterone suspension reviews or
- Applications of potassium-sparing diuretics (eg, amiloride, triamterene, or spironolactone).
During application of tacrolimus, the vaccine may have a lower efficiency, and to avoid the introduction of live attenuated vaccines. Clinically significant interaction The following interactions with drugs tacrolimus concomitant therapy observed in clinical use. The main mechanism of interaction is known. Drugs marked with an asterisk require changes to tacrolimus dosage in nearly all patients. Other drugs listed below may require adjustment of the dose in some cases. The following drugs inhibit CYP3A4, and it was shown that they increase tacrolimus levels in blood:
- * Ketoconazole, fluconazole *, itraconazole *, clotrimazole, voriconazole *
- Nifedipine, nicardipine
- * Erythromycin, clarithromycin, josamycin
- HIV Protease Inhibitors
- Danazol, ethinylestradiol
- Calcium channel antagonists such as diltiazem
The following preparations induce testosterone suspension reviews and it was shown that they lower blood levels of tacrolimus:
- * rifampicin (rifampin)
- phenytoin *
- St. John’s wort
Tacrolimus increased levels of phenytoin in the blood.
It is noted that both methylprednisolone raised and lowered levels of tacrolimus in the blood plasma.
There was increase in nephrotoxicity after applying any of the following drugs in conjunction with tacrolimus:
- Amphotericin B
It is shown that the half-life of ciclosporin was increased while the use of tacrolimus. Furthermore, can develop synergistic / additive effects. For these reasons, it is not recommended combined use of cyclosporin and tacrolimus when assigning tacrolimus patients who previously received cyclosporine. Interaction with food is noted that the grapefruit juice increases the level of tacrolimus in the blood by inhibiting the activity.