Drug interactions
Mifepristone + Tacrolimus
Severity: Major
Mifepristone and Tacrolimus: major interaction.
Last updated Sources: US FDA label
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
Mifepristone inhibits CYP3A4 and can raise tacrolimus blood concentrations. Tacrolimus has a narrow therapeutic index, so higher exposure can cause nephrotoxicity, neurotoxicity and QT prolongation.
What this interaction means in plain words
Mifepristone 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.
Mifepristone belongs to Endocrine; Tacrolimus belongs to Miscellaneous.
Why it happens
Mifepristone inhibits CYP3A4-mediated metabolism of tacrolimus in the liver and gut wall.
What to do
Avoid the combination when possible, particularly with chronic mifepristone dosing for Cushing syndrome. If it is unavoidable, monitor tacrolimus trough levels closely and reduce the dose as needed.
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
Other interactions of Mifepristone
- Apixaban + Mifepristone Contraindicated
- Argatroban + Mifepristone Contraindicated
- Cisapride + Mifepristone Contraindicated
- Cortisone + Mifepristone Contraindicated
- Cyclosporin + Mifepristone Contraindicated
- Dabigatran etexilate + Mifepristone Contraindicated
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 Mifepristone with Tacrolimus?
MediHelp rates the interaction as major. Mifepristone 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. Mifepristone inhibits CYP3A4 and can raise tacrolimus blood concentrations. Tacrolimus has a narrow therapeutic index, so higher exposure can cause nephrotoxicity, neurotoxicity and QT prolongation.
How serious is the interaction between Mifepristone 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 when possible, particularly with chronic mifepristone dosing for Cushing syndrome. If it is unavoidable, monitor tacrolimus trough levels closely and reduce the dose as needed.
What other medicines interact with Mifepristone?
MediHelp also lists interactions of Mifepristone with, for example, Apixaban, Argatroban, Cisapride. The full list is on the Mifepristone page.
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