Drug interactions
Diclofenac + Tacrolimus
Severity: Major
Diclofenac and Tacrolimus: major interaction.
Last updated Sources: UK SmPC
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
Both drugs can reduce renal blood flow and harm the kidney, so using them together raises the risk of acute kidney injury and hyperkalemia. This is a particular concern in transplant recipients whose graft function must be protected.
What this interaction means in plain words
Diclofenac 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.
Diclofenac belongs to Musculoskeletal; Tacrolimus belongs to Miscellaneous.
Why it happens
Additive nephrotoxicity: tacrolimus causes afferent arteriolar vasoconstriction while NSAIDs block compensatory vasodilatory prostaglandins.
What to do
Avoid the NSAID where possible and use an alternative analgesic such as paracetamol. If it is unavoidable, use the shortest course and monitor serum creatinine, potassium and tacrolimus trough levels closely.
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
- Diclofenac sodium Dexcel SR 75 mg Prolonged-release Tablets - SmPC sections 4.3/4.5 (names the partner; ".4 Special warnings and precautions for use). Drugs known to cause hyperkalemia: Concomitant treatment with potassium-sparing diuretics, ciclosporin, tacrolimus") — electronic medicines compendium (UK SmPC)
Other interactions of Diclofenac
- Diclofenac + Ketorolac Contraindicated
- Diclofenac + Ketorolac intranasal Contraindicated
- Aceclofenac + Diclofenac Major
- Acemetacin + Diclofenac Major
- Alteplase + Diclofenac Major
- Amiloride + Diclofenac Major
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 Diclofenac with Tacrolimus?
MediHelp rates the interaction as major. Diclofenac 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. Both drugs can reduce renal blood flow and harm the kidney, so using them together raises the risk of acute kidney injury and hyperkalemia. This is a particular concern in transplant recipients whose graft function must be protected.
How serious is the interaction between Diclofenac 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 NSAID where possible and use an alternative analgesic such as paracetamol. If it is unavoidable, use the shortest course and monitor serum creatinine, potassium and tacrolimus trough levels closely.
What other medicines interact with Diclofenac?
MediHelp also lists interactions of Diclofenac with, for example, Ketorolac, Ketorolac intranasal, Aceclofenac. The full list is on the Diclofenac page.
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