Drug interactions
Grapefruit + Tacrolimus
Severity: Moderate
Grapefruit 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
Grapefruit juice inhibits intestinal CYP3A4 and can raise tacrolimus blood levels. Increased exposure raises the risk of nephrotoxicity, neurotoxicity and hyperglycemia.
What this interaction means in plain words
Grapefruit 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.
Why it happens
Inhibition of intestinal CYP3A4 (and possibly P-gp) by grapefruit components reduces first-pass metabolism of tacrolimus.
What to do
Advise patients to avoid grapefruit and grapefruit juice throughout tacrolimus therapy. If intake changes, check tacrolimus trough levels.
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 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 Grapefruit with Tacrolimus?
MediHelp rates the interaction as moderate. Grapefruit 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. Grapefruit juice inhibits intestinal CYP3A4 and can raise tacrolimus blood levels. Increased exposure raises the risk of nephrotoxicity, neurotoxicity and hyperglycemia.
How serious is the interaction between Grapefruit 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: Advise patients to avoid grapefruit and grapefruit juice throughout tacrolimus therapy. If intake changes, check tacrolimus trough levels.
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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