Tacrolimus Interactions

492 known interactions for Tacrolimus. Click any interaction for the full evidence-based breakdown.

⚠️ Major (5)

Tacrolimus + CBD Oil🔴 AVOID — CBD potently inhibits CYP3A4/CYP3A5, potentially increasing tacrolimus blood levels 2-3 fold. Case reports document dangerous level spikes causing nephrotoxicity.
Tacrolimus + Clarithromycin🔴 AVOID — FDA-documented interaction. Clarithromycin strongly inhibits CYP3A4/P-gp, significantly increasing tacrolimus levels. Dose reduction and level monitoring essential. Consider azithromycin.
Tacrolimus + FluconazoleFDA-documented interaction. Tacrolimus dose reduction typically needed. Frequent tacrolimus level and renal function monitoring required.
Tacrolimus + Grapefruit🔴 AVOID — Tacrolimus has a narrow therapeutic index. Grapefruit inhibits CYP3A4, significantly increasing tacrolimus levels and risking nephrotoxicity. Do not consume grapefruit while on tacrolimus.
Tacrolimus + RifampinFDA-documented interaction. Rifampin can reduce tacrolimus levels by 50-80%. Massive dose increases may be needed. Organ rejection risk is high.

✅ Safe (487)