Tacrolimus and Ibuprofen: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Tacrolimus
Ibuprofen
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
Acute renal failure
Interaction Deep Dive
Two cases have been reported in which short-term use (3 to 4 doses) of ibuprofen was associated with anuria or oliguria in liver transplant patients receiving tacrolimus immunosuppression1. Tacrolimus concentrations were low to moderate in both patients, and the time-course was suggestive of an interaction. A possible explanation for this interaction is a greater dependence on renal prostaglandins by patients with liver dysfunction. The production of renal prostaglandins is inhibited by NSAIDs such as ibuprofen. If this suggested mechanism is correct, the interaction may occur with all NSAIDs.
Why it happens (mechanism)
Unknown
Common questions
Can I take Tacrolimus and Ibuprofen together?
Acute renal failure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tacrolimus and Ibuprofen 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 "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Tacrolimus or Ibuprofen 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)
- Sheiner PA, Mor E, Chodoff L, et al: Acute renal failure associated with the use of ibuprofen in two liver transplant recipients on FK506. Transplantation 1994; 57(7):1132-1133. DOI
Keep reading about Tacrolimus
Keep reading about Ibuprofen
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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