Drug interactions
Esomeprazole + Tacrolimus
Severity: Moderate
Esomeprazole and Tacrolimus: moderate 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
Esomeprazole can increase tacrolimus whole blood concentrations, mainly in patients who are CYP2C19 intermediate or poor metabolizers. Because tacrolimus has a narrow therapeutic index, higher levels risk nephrotoxicity and neurotoxicity.
What this interaction means in plain words
Esomeprazole and Tacrolimus can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Esomeprazole belongs to Gastrointestinal Tract; Tacrolimus belongs to Miscellaneous.
Why it happens
Inhibition of CYP2C19 (and possibly CYP3A4) reduces tacrolimus metabolism.
What to do
Check tacrolimus trough levels when starting, stopping or changing the dose of esomeprazole. Adjust tacrolimus dose per levels and renal function.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Esomeprazole
- Esomeprazole + Mavacamten Contraindicated
- Esomeprazole + Rilpivirine Contraindicated
- Acalabrutinib + Esomeprazole Major
- Atazanavir + Esomeprazole Major
- Citalopram + Esomeprazole Major
- Clopidogrel + Esomeprazole 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 Esomeprazole with Tacrolimus?
MediHelp rates the interaction as moderate. Esomeprazole and Tacrolimus can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Esomeprazole can increase tacrolimus whole blood concentrations, mainly in patients who are CYP2C19 intermediate or poor metabolizers. Because tacrolimus has a narrow therapeutic index, higher levels risk nephrotoxicity and neurotoxicity.
How serious is the interaction between Esomeprazole and Tacrolimus?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Check tacrolimus trough levels when starting, stopping or changing the dose of esomeprazole. Adjust tacrolimus dose per levels and renal function.
What other medicines interact with Esomeprazole?
MediHelp also lists interactions of Esomeprazole with, for example, Mavacamten, Rilpivirine, Acalabrutinib. The full list is on the Esomeprazole page.
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