Potent Interactions
Antibiotic that skyrockets tacrolimus levels
Erythromycin (or clarithromycin)
Regular insulin onset, peak, duration
Onset: 15-30 min
Peak: 2-4 hrs
Duration: 5-7 hr
Strong CYP3A4 inhibitor that raises sirolimus dramatically
ketoconazole
Folic acid is the treatment for megaloblastic anemia caused by long-term use of this drug class (NRTIs)
Nucleoside reverse transcriptase inhibitors (especially zidovudine)
Live vaccines contraindicated on high-dose tacrolimus/sirolimus
MMR, Varicella, Polio, Rotavirus, Yellow Fever, etc
Antidote for severe hypoglycemia after IV regular insulin
50 % dextrose (D50W) IV push (followed by infusion)
Ketoconazole or erythromycin with sirolimus
Massive increase in sirolimus levels
NPH given at 0800 peaks and risks hypoglycemia during this time window
2 PM – 8 PM (1400–2000) – the classic “afternoon/evening” hypoglycemia risk
Drug class that interacts dangerously with phentermine (within 14 days)
MAOIs
Diagnosis when diabetic on metformin has pH 7.1 and confusion
Metformin-associated lactic acidosis (MALA)