Tacrolimus and Lansoprazole: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Tacrolimus
Lansoprazole
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
Increased tacrolimus concentration and an increased risk of toxicity
Interaction Deep Dive
Concomitant use of tacrolimus with a weak or moderate CYP3A inhibitor like lansoprazole may increase tacrolimus whole blood trough concentrations and the risk of serious toxicity (eg, neurotoxicity, QT prolongation). If coadministered, monitor tacrolimus blood levels and reduce the dose as needed, and monitor for tacrolimus-associated adverse effects12. In a retrospective study, patients with connective tissue disease (N=35) treated with tacrolimus plus lansoprazole 15 mg/day had significant increases in tacrolimus blood concentrations 12 hours after administration with no significant increases in the incidence of kidney dysfunction or glucose intolerance compared with rabeprazole plus tacrolimus, or tacrolimus alone 3.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated tacrolimus metabolism
Literature reports
1 report — tap to read
a) In a retrospective study, patients with connective tissue disease treated with tacrolimus plus lansoprazole 15 mg/day (N=11) had significant increases in tacrolimus blood concentrations 12 hours after administration compared with rabeprazole plus tacrolimus (N=11), or tacrolimus alone (N=13; 7.9 vs 4.4 and 3.1 nanograms/mL). There were no significant increases in the incidence of kidney dysfunction or glucose intolerance in the 3 groups (increases in serum creatinine, HbA1C, or fasting blood sugar) 3.
Common questions
Can I take Tacrolimus and Lansoprazole together?
Increased tacrolimus concentration and an increased risk of toxicity Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tacrolimus and Lansoprazole 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 "established". Well documented — supported by controlled studies or strong clinical data.
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 Lansoprazole 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 (3)
- Product Information: ENVARSUS XR(R) oral extended-release tablets, tacrolimus oral extended-release tablets. Veloxis Pharmaceuticals Inc (per FDA), Cary, NC, 2023. DailyMed
- 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
- Isoda K, Takeuchi T, Hirano-Kuwata S, et al: The proton pump inhibitor lansoprazole, but not rabeprazole, the increased blood concentrations of calcineurin inhibitors in Japanese patients with connective tissue diseases. Intern Med 2014; 53(13):1413-1418. PubMed
Keep reading about Tacrolimus
Keep reading about Lansoprazole
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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