Drug Interaction Report

Tacrolimus and Cyclosporine Injection: Interaction Details

A pharmacist-reviewed analysis of the Tacrolimus and Cyclosporine Injection interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Tacrolimus

Astagraf Astagraf XL® Envarsus Envarsus XR® Prograf Prograf®
+

Cyclosporine Injection

Atopica Cequa Cyclavance Gengraf Modulis Neoral Optimmune Restasis
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
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.

Of 157 documented Tacrolimus interactions, 150 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
delayed
Evidence
theoretical
Severity
Major

What happens

Increased tacrolimus exposure and an increased risk of nephrotoxicity

Interaction Deep Dive

During conversion from cycloSPORINE to tacrolimus (rescue therapy), cycloSPORINE administered concomitantly with tacrolimus increases trough cycloSPORINE levels; this has been associated with nephrotoxicity134. This interaction appears to be related to inhibition of cycloSPORINE metabolism 567 and additive adverse effects 8. Avoid coadministration of tacrolimus and cycloSPORINE. Prior to initiation, tacrolimus or cycloSPORINE should be discontinued for at least 24 hours; consider further delays in patients with elevated levels of either drug 1.

Why it happens (mechanism)

Inhibition of CYP3A mediated metabolism of tacrolimus; reduced cycloSPORINE metabolism and additive adverse effects

Common questions

Can I take Tacrolimus and Cyclosporine Injection together?

Increased tacrolimus exposure and an increased risk of nephrotoxicity Always confirm with your pharmacist or prescriber before making any change.

How serious is the Tacrolimus and Cyclosporine 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 "delayed". Effects tend to build up gradually over days to weeks.

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 Cyclosporine 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 (8)

  1. 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, 2023. DailyMed
  2. Product Information: ENVARSUS XR(R) oral extended-release tablets, tacrolimus oral extended-release tablets. Veloxis Pharmaceuticals Inc (per FDA), Cary, NC, 2023. DailyMed
  3. Starzl TE, Todo S, Fung J, et al: FK 506 for liver, kidney, and pancreas transplantation. Lancet 1989; 2:1000-1004. PubMed
  4. McCauley J, Fung J, Jain A, et al: The effects of FK 506 on renal function after liver transplantation. Transplant Proc 1990; 22(suppl 1):17-20.
  5. Omar G, Shah IA, Thomson AW, et al: FK-506 inhibition of cyclosporine metabolism by human liver microsomes. Transplant Proc 1991; 23:934-935.
  6. Fung JJ, Todo S, Tzakis A, et al: Conversion of liver allograft recipients from cyclosporine to FK 506-based immunosuppression: benefits and pitfalls. Transplant Proc 1991; 23:14-21.
  7. Armitage JM, Kormos RL, Griffith BP, et al: A clinical trial of FK 506 as primary and rescue immunosuppression in cardiac transplantation. Transplant Proc 1991; 23:1149-1152.
  8. Lake JR, Roberts JP, & Ascher NL: Maintenance immunosuppression after liver transplantation. Semin Liver Dis 1992; 12:73-79. PubMed
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Tacrolimus

Keep reading about Tacrolimus

All Tacrolimus interactions (157) Tacrolimus drug information
Also serious with: Ketoconazole Topical Lefamulin Lenacapavir Injection Perindopril
Cyclosporine Injection

Keep reading about Cyclosporine Injection

All Cyclosporine Injection interactions (545) Cyclosporine Injection drug information
Also serious with: Ezetimibe Grazoprevir Sitaxsentan Simvastatin
Beyond drug–drug

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:

Tacrolimus + Activated Charcoal American Hellebore Arsenic Asarabacca Cesium Ephedra Grapefruit Siberian Cocklebur + 194 more

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.