Drug interactions
Tacrolimus + Tofacitinib
Severity: Major
Tacrolimus and Tofacitinib: 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
Combining a JAK inhibitor with a calcineurin inhibitor produces profound immunosuppression and raises the risk of serious opportunistic infections and lymphoproliferative disorders. Labeling advises against use with potent immunosuppressants such as tacrolimus.
What this interaction means in plain words
Tacrolimus and Tofacitinib 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.
Tacrolimus belongs to Miscellaneous; Tofacitinib belongs to Musculoskeletal.
Why it happens
Additive immunosuppression from JAK inhibition and calcineurin inhibition.
What to do
Avoid concurrent use where possible. If it is required, use the lowest effective doses and monitor for infection 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?
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Other interactions of Tofacitinib
- Baricitinib + Tofacitinib Contraindicated
- Cladribine + Tofacitinib Contraindicated
- Tofacitinib + Upadacitinib Contraindicated
- Abatacept + Tofacitinib Major
- Anti-thymocyte + Tofacitinib Major
- Antithymocyte globulin equine + Tofacitinib Major
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 Tacrolimus with Tofacitinib?
MediHelp rates the interaction as major. Tacrolimus and Tofacitinib 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. Combining a JAK inhibitor with a calcineurin inhibitor produces profound immunosuppression and raises the risk of serious opportunistic infections and lymphoproliferative disorders. Labeling advises against use with potent immunosuppressants such as tacrolimus.
How serious is the interaction between Tacrolimus and Tofacitinib?
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 concurrent use where possible. If it is required, use the lowest effective doses and monitor for infection and tacrolimus trough levels.
What other medicines interact with Tofacitinib?
MediHelp also lists interactions of Tofacitinib with, for example, Baricitinib, Cladribine, Upadacitinib. The full list is on the Tofacitinib page.
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