Tacrolimus

Tacrolimus, also known by the brand name Tacrolimus (Prograf), is a medicine in the immunosuppressants family. It is used to reduce immune activity. This page provides educational reference about potential interactions between Tacrolimus and supplements or other medicines, helping readers identify what else they may be taking that could warrant discussion with a clinician. It is not medical advice.

Tacrolimus has a narrow therapeutic index, so changes in its blood concentration can have important consequences, particularly for transplant recipients. St. John's Wort and Echinacea can induce CYP3A4 and P-glycoprotein, substantially lowering tacrolimus levels and increasing the risk of organ transplant rejection. Berberine, CBD (Cannabidiol), and Quercetin can inhibit these pathways, raising tacrolimus exposure and the risk of nephrotoxicity, neurotoxicity, or excessive immunosuppression. Potassium is also a significant concern because tacrolimus can impair renal potassium handling, increasing the risk of severe hyperkalemia and cardiac arrhythmia when additional potassium is used.

Curcumin has a case report linking heavy turmeric intake with increased tacrolimus trough concentrations and calcineurin-inhibitor nephrotoxicity; the interaction may depend on the product and dose. Green Tea Extract (EGCG), Oregano Oil, and Turkey Tail may also increase exposure through CYP3A4 or transporter effects, while Turkey Tail and several other immune-modulating products may counteract immunosuppression. Aloe Vera, American Ginseng, Black Seed Oil, Cordyceps, Garlic, Horny Goat Weed (Epimedium), Milk Thistle (Silymarin), Reishi, Panax Ginseng, and Resveratrol have limited, theoretical, product-specific, or uncertain evidence, but their potential effects matter because tacrolimus levels are closely balanced.

Ashwagandha and Holy Basil (Tulsi) may oppose tacrolimus's immunosuppressive effects through immune modulation, although the concern is primarily theoretical. Magnesium can be useful for addressing tacrolimus-associated renal magnesium wasting, but repletion may be difficult and requires laboratory monitoring. Anyone taking tacrolimus should discuss these supplements, including changes in use, with their transplant team, prescriber, or pharmacist so tacrolimus levels and kidney-related toxicity can be monitored appropriately.