Tacrolimus and Buprenorphine: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Buprenorphine
Tacrolimus
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.
Both buprenorphine and tacrolimus can, on their own, affect your heart's electrical rhythm in a way doctors call QT prolongation. When two medicines that do this are taken together, the small effects can add up, which could slightly raise the chance of an irregular heartbeat.
I want to be clear: this concern is theoretical, meaning it's based on how the drugs work rather than lots of real-world reports. Many people take combinations like this safely under supervision. The important thing is that your care team knows you're on both, especially if you have a heart condition or low potassium or magnesium. They can keep an eye on things and manage this well.
Effect: Additive QT-interval prolongation when buprenorphine and tacrolimus are co-administered. This is a pharmacodynamic interaction; neither drug is a prodrug and the direction is additive electrophysiologic risk, not altered clearance.
- Severity/evidence: Rated major but theoretical; combined risk is not well quantified.
- Onset: Unspecified.
- Management: Assess baseline risk factors (hypokalemia, hypomagnesemia, bradycardia, CHF, congenital/baseline long QT, recent AF conversion, digitalis therapy). Correct electrolytes, consider baseline and follow-up ECG, and monitor QTc if used together.
What happens
An increased risk of QT interval prolongation
Interaction Deep Dive
The simultaneous administration of buprenorphine alongside agents capable of prolonging the QT interval should be avoided342. It remains unknown what risk arises from pairing buprenorphine with other QT-prolonging drugs. When buprenorphine is being prescribed for patients who carry risk factors including hypokalemia, bradycardia, recent cardioversion from atrial fibrillation, congestive heart failure, treatment with digitalis, baseline QT prolongation, subclinical long-QT syndrome, or severe hypomagnesemia, clinicians should weigh these considerations in their decisions 1.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
Keep taking both medicines as prescribed unless your doctor or pharmacist tells you otherwise. Here is what a care team typically does:
- Reviews your other medicines and any heart history for QT risk.
- Checks and corrects potassium and magnesium levels if they are low.
- May order an ECG before and during treatment to watch your heart rhythm.
- May adjust or choose an alternative if your combined risk is high; any changes will be individualized by your team.
Tell your pharmacist or prescriber if you feel faint, dizzy, or notice a pounding or irregular heartbeat.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Tacrolimus and Buprenorphine together?
Buprenorphine and tacrolimus can both nudge the heart's QT interval, and together the effect may add up. This risk is theoretical, so keep taking both as prescribed and let your care team check your electrolytes and heart rhythm. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tacrolimus and Buprenorphine 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 Buprenorphine interaction managed?
Keep taking both medicines as prescribed unless your doctor or pharmacist tells you otherwise. Here is what a care team typically does: Reviews your other medicines and any heart history for QT risk. Checks and corrects potassium and magnesium levels if they are low. May order an ECG before and during treatment to watch your heart rhythm. May adjust or choose an alternative if your combined risk i… 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 Buprenorphine 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 (4)
- Product Information: BRIXADI(TM) subcutaneous extended-release injection, buprenorphine subcutaneous extended-release injection. Braeburn Inc (per FDA), Plymouth Meeting, PA, 2023. DailyMed
- Product Information: BUTRANS(R) transdermal system patch, buprenorphine transdermal system patch. Purdue Pharma L.P. (per FDA), Stamford, CT, 2016. DailyMed
- Product Information: BELBUCA(TM) buccal film, buprenorphine buccal film. Endo Pharmaceuticals Inc. (per FDA), Malvern, PA, 2016.
- Product Information: BUPRENEX(R) intravenous injection, intramuscular injection, buprenorphine HCl intravenous injection, intramuscular injection. Indivior Inc. (per DailyMed), Richmond, VA, 2016. DailyMed
Keep reading about Buprenorphine
Keep reading about Tacrolimus
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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