Drug interactions
Sacubitril / valsartan + Tacrolimus
Severity: Moderate
Sacubitril / valsartan 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
Both agents can reduce renal function and raise serum potassium, so combining them increases the risk of hyperkalemia and acute kidney injury. Tacrolimus may also increase valsartan exposure through transporter effects, though this is less well established.
What this interaction means in plain words
Sacubitril / valsartan 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
Additive hyperkalemia and renal hemodynamic effects from calcineurin inhibition and RAAS blockade, with possible OATP1B1 inhibition raising valsartan exposure.
What to do
Monitor serum potassium, creatinine and blood pressure after initiation and dose changes. Adjust or stop one agent if hyperkalemia or renal decline develops.
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 Sacubitril / valsartan with Tacrolimus?
MediHelp rates the interaction as moderate. Sacubitril / valsartan 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. Both agents can reduce renal function and raise serum potassium, so combining them increases the risk of hyperkalemia and acute kidney injury. Tacrolimus may also increase valsartan exposure through transporter effects, though this is less well established.
How serious is the interaction between Sacubitril / valsartan 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: Monitor serum potassium, creatinine and blood pressure after initiation and dose changes. Adjust or stop one agent if hyperkalemia or renal decline develops.
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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