Drug interactions
Tacrolimus + Verapamil
Severity: Major
Tacrolimus and Verapamil: 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
Verapamil can raise tacrolimus blood levels, increasing the risk of nephrotoxicity, neurotoxicity and hyperglycemia.
What this interaction means in plain words
Tacrolimus and Verapamil 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; Verapamil belongs to Cardiovascular.
Why it happens
Verapamil inhibits CYP3A4 and P-glycoprotein, reducing tacrolimus metabolism and efflux.
What to do
Monitor tacrolimus trough levels and renal function when verapamil is started, changed or stopped. Reduce the tacrolimus 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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Other interactions of Verapamil
- Dofetilide + Verapamil Contraindicated
- Flibanserin + Verapamil Contraindicated
- Lomitapide + Verapamil Contraindicated
- Lonafarnib + Verapamil Contraindicated
- Pimozide + Verapamil Contraindicated
- Acebutolol + Verapamil 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 Verapamil?
MediHelp rates the interaction as major. Tacrolimus and Verapamil 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. Verapamil can raise tacrolimus blood levels, increasing the risk of nephrotoxicity, neurotoxicity and hyperglycemia.
How serious is the interaction between Tacrolimus and Verapamil?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor tacrolimus trough levels and renal function when verapamil is started, changed or stopped. Reduce the tacrolimus dose as needed.
What other medicines interact with Verapamil?
MediHelp also lists interactions of Verapamil with, for example, Dofetilide, Flibanserin, Lomitapide. The full list is on the Verapamil page.
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