MAJOR — Use With Caution
🔴 AVOID — CBD potently inhibits CYP3A4/CYP3A5, potentially increasing tacrolimus blood levels 2-3 fold. Case reports document dangerous level spikes causing nephrotoxicity.
Evidence level: STRONG
CBD can dramatically increase tacrolimus (immunosuppressant) levels in your blood. This is dangerous — tacrolimus has a very narrow therapeutic window and elevated levels can damage your kidneys.
CBD potently inhibits CYP3A4 and CYP3A5, the primary enzymes metabolizing tacrolimus. This can increase tacrolimus blood levels 2-3 fold, risking nephrotoxicity and immunosuppressant toxicity. Case reports document dangerous tacrolimus level spikes.
Do NOT use CBD products without telling your transplant team. If you start or stop CBD, tacrolimus levels must be monitored within days. Dose adjustments will likely be needed. This interaction has caused hospitalizations.
Take Tacrolimus as prescribed. CBD Oil can typically be taken with a meal at a different time. As a general rule, space botanicals 1-2 hours from prescription medications. St. John's Wort is the most interaction-prone botanical — it affects dozens of drugs via CYP enzyme induction. Always inform your prescriber about herbal supplements.
Higher risk for: elderly, those with liver or kidney impairment, polypharmacy (5+ medications), recent medication changes, or those with multiple chronic conditions. Consult your pharmacist for specific risk factors.
Tremor, headache, nausea, diarrhea, elevated creatinine, decreased urine output, confusion. These may indicate tacrolimus toxicity — contact your transplant team immediately.
No urgent need to discuss, but always keep your doctor informed of your full supplement and medication list. An up-to-date list helps them make the best treatment decisions.
Discuss safer alternatives with your healthcare provider. They can recommend substitutions based on your specific health goals while minimizing interaction risks. Always bring a complete list of everything you take to your appointments.
CBD can dramatically increase tacrolimus (immunosuppressant) levels in your blood. This is dangerous — tacrolimus has a very narrow therapeutic window and elevated levels can damage your kidneys.
Take Tacrolimus as prescribed. CBD Oil can typically be taken with a meal at a different time. As a general rule, space botanicals 1-2 hours from prescription medications. St. John's Wort is the most interaction-prone botanical — it affects dozens of drugs via CYP enzyme induction. Always inform your prescriber about herbal supplements.
Tremor, headache, nausea, diarrhea, elevated creatinine, decreased urine output, confusion. These may indicate tacrolimus toxicity — contact your transplant team immediately.
Discuss safer alternatives with your healthcare provider. They can recommend substitutions based on your specific health goals while minimizing interaction risks. Always bring a complete list of everything you take to your appointments.
No urgent need to discuss, but always keep your doctor informed of your full supplement and medication list. An up-to-date list helps them make the best treatment decisions.
Or browse the full interaction database (121,000+ pairs).