Tacrolimus and Abrocitinib: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 10, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Tacrolimus
Abrocitinib
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Here's what's going on: Tacrolimus (Prograf, Envarsus, Astagraf) is an anti-rejection and immune medicine that your body has to keep in a very tight range. Too little and it doesn't protect you; too much and it can harm your kidneys or cause other side effects. Abrocitinib (Cibinqo) can slow down one of the "pumps" (called P-glycoprotein) that helps move tacrolimus out of your body.
Because of that, taking both together may let more tacrolimus build up. This is based on how the drugs work in theory, not on strong studies, so please don't be alarmed. Keep taking both as prescribed and let your care team know you're on both. They can check your levels and adjust things to keep you safe.
Mechanism: Abrocitinib inhibits P-glycoprotein (P-gp)-mediated efflux. Tacrolimus is a P-gp substrate, so coadministration may increase tacrolimus exposure (AUC/Cmax). Neither drug is a prodrug here; the direction is increased tacrolimus effect and toxicity risk.
- Direction: higher tacrolimus concentrations
- Severity: major; tacrolimus is narrow therapeutic index
- Onset: unspecified
- Evidence: theoretical (P-gp inhibition, extrapolated from substrates like digoxin)
Management: If coadministration is necessary, monitor tacrolimus trough levels more closely and watch for nephrotoxicity, neurotoxicity, tremor, hyperkalemia, and glucose changes. Individualize and titrate the tacrolimus dose per levels and clinical response.
What happens
Increased exposure of P-glycoprotein substrate
Interaction Deep Dive
When a P-gp substrate that has a narrow therapeutic index (digoxin, for example) is given together with abrocitinib, which inhibits P-gp, exposure to that substrate may rise. Should concurrent use be required, apply appropriate monitoring or adjust the dose of the P-gp substrate in cases where minor changes in concentration could result in serious or life-threatening toxicities1.
Why it happens (mechanism)
Inhibition of P-glycoprotein-mediated efflux transport by abrocitinib
How to manage this interaction
The good news: your care team can manage this by keeping a close eye on you.
- Keep taking both exactly as prescribed unless your doctor tells you otherwise.
- Your team may check your tacrolimus blood levels more often, especially when abrocitinib is started or stopped.
- Your tacrolimus dose may need to be adjusted and individualized based on those levels.
- Report symptoms like new tremor, headache, less urine, swelling, or feeling unusually unwell.
Let your pharmacist and prescriber know you take both so they can coordinate monitoring.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Tacrolimus and Abrocitinib together?
Abrocitinib may raise tacrolimus levels by blocking a drug-transport pump, and since tacrolimus has a narrow safety window, your care team may check your levels and adjust the dose. Keep taking both as prescribed and tell your pharmacist or doctor you're on both. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tacrolimus and Abrocitinib interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Tacrolimus and Abrocitinib interaction managed?
The good news: your care team can manage this by keeping a close eye on you. Keep taking both exactly as prescribed unless your doctor tells you otherwise. Your team may check your tacrolimus blood levels more often, especially when abrocitinib is started or stopped. Your tacrolimus dose may need to be adjusted and individualized based on those levels. Report symptoms like new tremor, headache, le… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Tacrolimus or Abrocitinib need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: CIBINQO(TM) oral tablets, abrocitinib oral tablets. Pfizer Labs (per FDA), New York, NY, 2022. DailyMed
Keep reading about Tacrolimus
Keep reading about Abrocitinib
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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