Drug interactions
Cannabidiol + Tacrolimus
Severity: Major
Cannabidiol and Tacrolimus: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Cannabidiol inhibits CYP3A4 and P-gp and can raise tacrolimus concentrations. This may cause toxicity, including renal impairment and neurotoxicity.
What this interaction means in plain words
Cannabidiol and Tacrolimus can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Cannabidiol belongs to Central Nervous System; Tacrolimus belongs to Miscellaneous.
Why it happens
Cannabidiol inhibits CYP3A4 and P-glycoprotein, reducing tacrolimus metabolism and efflux.
What to do
Monitor tacrolimus trough levels and renal function after starting or changing cannabidiol, and reduce the tacrolimus dose as needed.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Tacrolimus
- Adenovirus types 4 and 7 live + Tacrolimus Contraindicated
- Bcg vaccine live + Tacrolimus Contraindicated
- Cidofovir + Tacrolimus Contraindicated
- Cyclosporin + Tacrolimus Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Tacrolimus Contraindicated
- Measles mumps and rubella vaccine live + Tacrolimus Contraindicated
Other interactions of Cannabidiol
- Cannabidiol + Phenytoin Major
- Cannabidiol + Sodium valproate Major
- Abiraterone + Cannabidiol Moderate
- Alogliptin-pioglitazone + Cannabidiol Moderate
- Amiodarone + Cannabidiol Moderate
- Amobarbital + Cannabidiol Moderate
Frequently asked questions
Can I take Cannabidiol with Tacrolimus?
MediHelp rates the interaction as major. Cannabidiol and Tacrolimus can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Cannabidiol inhibits CYP3A4 and P-gp and can raise tacrolimus concentrations. This may cause toxicity, including renal impairment and neurotoxicity.
How serious is the interaction between Cannabidiol and Tacrolimus?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor tacrolimus trough levels and renal function after starting or changing cannabidiol, and reduce the tacrolimus dose as needed.
What other medicines interact with Tacrolimus?
MediHelp also lists interactions of Tacrolimus with, for example, Adenovirus types 4 and 7 live, Bcg vaccine live, Cidofovir. The full list is on the Tacrolimus page.
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