MAJOR — Use With Caution
🔴 AVOID — Tacrolimus has a narrow therapeutic index. Grapefruit inhibits CYP3A4, significantly increasing tacrolimus levels and risking nephrotoxicity. Do not consume grapefruit while on tacrolimus.
Evidence level: STRONG
Grapefruit can dramatically increase tacrolimus levels. Since tacrolimus has a very narrow safety margin, this can damage your kidneys and cause serious toxicity.
Grapefruit irreversibly inhibits intestinal CYP3A4, significantly increasing tacrolimus bioavailability. Tacrolimus has a very narrow therapeutic index — small increases cause nephrotoxicity.
Completely avoid grapefruit and grapefruit juice while taking tacrolimus. Even small amounts can cause dangerous level increases. Pomelo and Seville oranges should also be avoided.
Be consistent with how you take Tacrolimus relative to meals — take it with food or without food consistently each day. Grapefruit — sudden large changes in diet composition can affect how your body processes many medications. Grapefruit, leafy greens, and high-fiber foods are the most common food-drug interaction culprits.
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, decreased urine output, confusion — signs of 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.
Adjust the timing or quantity of Grapefruit relative to your medication. Maintain consistent daily intake rather than large sporadic amounts. Your pharmacist can advise on specific timing windows.
Grapefruit can dramatically increase tacrolimus levels. Since tacrolimus has a very narrow safety margin, this can damage your kidneys and cause serious toxicity.
Be consistent with how you take Tacrolimus relative to meals — take it with food or without food consistently each day. Grapefruit — sudden large changes in diet composition can affect how your body processes many medications. Grapefruit, leafy greens, and high-fiber foods are the most common food-drug interaction culprits.
Tremor, headache, nausea, diarrhea, decreased urine output, confusion — signs of tacrolimus toxicity. Contact your transplant team immediately.
Adjust the timing or quantity of Grapefruit relative to your medication. Maintain consistent daily intake rather than large sporadic amounts. Your pharmacist can advise on specific timing windows.
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).