Drug interactions
Tacrolimus + Topiramate
Severity: Moderate
Tacrolimus and Topiramate: 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
Tacrolimus has a narrow therapeutic index and is a CYP3A4/P-gp substrate, so any induction may lower blood levels and raise rejection risk. Topiramate is a weak inducer, so a large effect is unlikely, but a small number of reports suggest altered levels.
What this interaction means in plain words
Tacrolimus and Topiramate 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.
Tacrolimus belongs to Miscellaneous; Topiramate belongs to Central Nervous System.
Why it happens
Possible weak CYP3A4 induction by topiramate increases tacrolimus metabolism.
What to do
Measure tacrolimus trough levels when topiramate is started, changed or stopped, and adjust the tacrolimus dose accordingly.
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 Topiramate
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 Topiramate?
MediHelp rates the interaction as moderate. Tacrolimus and Topiramate 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. Tacrolimus has a narrow therapeutic index and is a CYP3A4/P-gp substrate, so any induction may lower blood levels and raise rejection risk. Topiramate is a weak inducer, so a large effect is unlikely, but a small number of reports suggest altered levels.
How serious is the interaction between Tacrolimus and Topiramate?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Measure tacrolimus trough levels when topiramate is started, changed or stopped, and adjust the tacrolimus dose accordingly.
What other medicines interact with Topiramate?
MediHelp also lists interactions of Topiramate with, for example, Benzhydrocodone / acetaminophen, Buprenorphine long-acting, Buprenorphine subdermal implant. The full list is on the Topiramate page.
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