Drug interactions
Carbamazepine + Tacrolimus
Severity: Major
Carbamazepine and Tacrolimus: major interaction.
Last updated Sources: US FDA label
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
Carbamazepine can substantially lower tacrolimus concentrations, increasing rejection risk. Levels may rise toward toxicity after carbamazepine is stopped.
What this interaction means in plain words
Carbamazepine 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.
Carbamazepine belongs to Central Nervous System; Tacrolimus belongs to Miscellaneous.
Why it happens
Induction of intestinal and hepatic CYP3A4 and P-glycoprotein increases tacrolimus clearance.
What to do
Monitor tacrolimus trough levels frequently and adjust the dose when carbamazepine is started, changed or stopped. Consider a non-inducing anticonvulsant.
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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References
Other interactions of Carbamazepine
- Artemether / lumefantrine + Carbamazepine Contraindicated
- Cabotegravir + Carbamazepine Contraindicated
- Carbamazepine + Delamanid Contraindicated
- Carbamazepine + Dienogest / estradiol valerate Contraindicated
- Carbamazepine + Doravirine Contraindicated
- Carbamazepine + Elbasvir / grazoprevir Contraindicated
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
Frequently asked questions
Can I take Carbamazepine with Tacrolimus?
MediHelp rates the interaction as major. Carbamazepine 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. Carbamazepine can substantially lower tacrolimus concentrations, increasing rejection risk. Levels may rise toward toxicity after carbamazepine is stopped.
How serious is the interaction between Carbamazepine 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 frequently and adjust the dose when carbamazepine is started, changed or stopped. Consider a non-inducing anticonvulsant.
What other medicines interact with Carbamazepine?
MediHelp also lists interactions of Carbamazepine with, for example, Artemether / lumefantrine, Cabotegravir, Delamanid. The full list is on the Carbamazepine page.
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