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Drug interactions

Mefenamic acid + Tacrolimus

Severity: Major

Mefenamic acid 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

NSAIDs constrict the afferent renal arterioles by blocking prostaglandin synthesis, and tacrolimus does the same through its own vasoconstrictive effect. Together they can cause additive acute kidney injury and hyperkalemia, especially in transplant recipients with a limited renal reserve.

What this interaction means in plain words

Mefenamic acid 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.

Mefenamic acid belongs to Musculoskeletal; Tacrolimus belongs to Miscellaneous.

Evidence level: Moderate

Why it happens

Additive renal vasoconstriction from prostaglandin inhibition (NSAID) and calcineurin inhibitor nephrotoxicity.

What to do

Avoid the combination where possible and use paracetamol or another alternative. If it is unavoidable, use the shortest course and monitor serum creatinine, potassium and tacrolimus trough levels.

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?

Bring a full list of your medicines, including over-the-counter products, supplements and herbal remedies, to every pharmacy visit.

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Frequently asked questions

Can I take Mefenamic acid with Tacrolimus?

MediHelp rates the interaction as major. Mefenamic acid 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. NSAIDs constrict the afferent renal arterioles by blocking prostaglandin synthesis, and tacrolimus does the same through its own vasoconstrictive effect. Together they can cause additive acute kidney injury and hyperkalemia, especially in transplant recipients with a limited renal reserve.

How serious is the interaction between Mefenamic acid 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 where possible and use paracetamol or another alternative. If it is unavoidable, use the shortest course and monitor serum creatinine, potassium and tacrolimus trough levels.

What other medicines interact with Mefenamic acid?

MediHelp also lists interactions of Mefenamic acid with, for example, Ketorolac intranasal, Ketorolac, Aceclofenac. The full list is on the Mefenamic acid page.

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