Drug General Information (ID: DDIY36LR7P)
Drug Name			Tacrolimus		Drug Info		Sodium bicarbonate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Immunosuppressive Agents				Antidiarrheals
Structure

Mechanism of Tacrolimus-Sodium bicarbonate Interaction (Severity Level: Moderate)
Altered gastric pH Click to Show/Hide Mechanism Graph
Drug Name		Tacrolimus				Sodium bicarbonate
Mechanism		Gastric pH sensitive				Gastric alkalinizer
Key Mechanism Factor 1
		Factor Name		Gastric pH
		Factor Description		The normal pH range of gastric acid is between 1.5 and 3.5 and is highly acidic, consisting mainly of hydrochloric acid. Changes in the pH of the stomach can alter the absorption of drugs.
Mechanism Description		Decreased absorption of Tacrolimus due to altered gastric pH caused by Sodium bicarbonate

Recommended Action
Management		Until more data are available, it may be prudent to separate the times of administration of tacrolimus and sodium bicarbonate by at least two hours.

References
1	Product Information. Prograf (tacrolimus). Fujisawa, Deerfield, IL.
2	Venkataramanan R, Swaminathan A, Prasad T, et al "Clinical pharmacokinetics of tacrolimus." Clin Pharmacokinet 29 (1995): 404-30. [PMID: 8787947]