Tacrolimus and Caspofungin Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Tacrolimus
Caspofungin Injection
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.
What happens
Reduced tacrolimus exposure
Interaction Deep Dive
Concomitant use of tacrolimus with caspofungin may decrease the tacrolimus whole blood trough concentrations2. Caspofungin decreased tacrolimus AUC and Cmax. Monitor tacrolimus blood levels and adjust the dose if needed 12.
Why it happens (mechanism)
Unknown
Literature reports
1 report — tap to read
a) Caspofungin reduced the AUC of tacrolimus by approximately 20%, Cmax by 16%, and 12-hour blood concentration by 26% in healthy subjects. Subjects received caspofungin 70 mg daily for 10 days, then two doses of tacrolimus 0.1 mg/kg 12 hours apart. No effect of tacrolimus on caspofungin kinetics has been observed 12.
Common questions
Can I take Tacrolimus and Caspofungin Injection together?
Reduced tacrolimus exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tacrolimus and Caspofungin Injection 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 strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Tacrolimus or Caspofungin Injection 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 (2)
- Product Information: CANCIDAS(R) IV infusion, caspofungin acetate IV infusion. Merck & Co,Inc, Whitehouse Station, NJ, 2008.
- Product Information: PROGRAF(R) oral capsules, oral granules for suspension, intravenous injection, tacrolimus oral capsules, oral granules for suspension, intravenous injection. Astellas Pharma US Inc (per FDA), Northbrook, IL, 2022. DailyMed
Keep reading about Tacrolimus
Keep reading about Caspofungin Injection
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
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