Drug interactions
Marijuana + Tacrolimus
Severity: Moderate
Marijuana 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
Cannabidiol in cannabis can inhibit CYP3A4 and may increase tacrolimus concentrations, as shown in case reports. Tacrolimus toxicity such as renal impairment or tremor may follow.
What this interaction means in plain words
Marijuana 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
Cannabinoids, particularly cannabidiol, inhibit CYP3A4 and reduce tacrolimus metabolism.
What to do
Ask patients about cannabis use and monitor tacrolimus trough levels if use starts, stops or changes. Adjust the dose and monitor 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 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 Marijuana with Tacrolimus?
MediHelp rates the interaction as moderate. Marijuana 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. Cannabidiol in cannabis can inhibit CYP3A4 and may increase tacrolimus concentrations, as shown in case reports. Tacrolimus toxicity such as renal impairment or tremor may follow.
How serious is the interaction between Marijuana 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: Ask patients about cannabis use and monitor tacrolimus trough levels if use starts, stops or changes. Adjust the dose and monitor renal function.
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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