Drug interactions
Dabigatran + Tacrolimus
Severity: Major
Dabigatran 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
Tacrolimus can inhibit P-glycoprotein and raise dabigatran exposure, increasing bleeding risk. The risk is greater in patients with renal impairment, which is common in transplant recipients.
What this interaction means in plain words
Dabigatran 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.
Why it happens
Tacrolimus inhibits intestinal and renal P-gp efflux of dabigatran etexilate, raising dabigatran concentrations.
What to do
Avoid the combination in patients with significant renal impairment or consider another anticoagulant; otherwise monitor renal function and for bleeding, reducing the dabigatran dose per labeling.
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
Frequently asked questions
Can I take Dabigatran with Tacrolimus?
MediHelp rates the interaction as major. Dabigatran 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. Tacrolimus can inhibit P-glycoprotein and raise dabigatran exposure, increasing bleeding risk. The risk is greater in patients with renal impairment, which is common in transplant recipients.
How serious is the interaction between Dabigatran 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: Avoid the combination in patients with significant renal impairment or consider another anticoagulant; otherwise monitor renal function and for bleeding, reducing the dabigatran dose per labeling.
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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