Tacrolimus and Lisinopril: 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
Tacrolimus
Lisinopril
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 of these medicines can raise the potassium level in your blood. Tacrolimus (Prograf, Envarsus) helps keep your body from rejecting a transplant, and lisinopril (Zestril, Prinivil) treats blood pressure and protects your heart and kidneys. When taken together, they can push potassium higher than usual. Too much potassium can affect how your heart beats.
Here's the reassuring part: this is easy for your care team to keep an eye on. They can check your potassium with a simple blood test now and then. Please keep taking both medicines as prescribed, and mention any muscle weakness, tingling, or irregular heartbeat to your pharmacist or doctor.
Effect: Additive risk of hyperkalemia with concomitant tacrolimus and lisinopril (an ACE inhibitor).
- Mechanism: Not established. Tacrolimus can impair renal potassium excretion; ACE inhibitors reduce aldosterone, decreasing renal potassium loss. The combined effect can elevate serum K+. Neither agent requires this interaction to be interpreted through prodrug activation.
- Direction/magnitude: Increased serum potassium; magnitude not quantified.
- Onset: Unspecified.
- Evidence: Theoretical; rated major.
- Management: Monitor serum potassium periodically, particularly with renal impairment, volume depletion, or other K+-raising agents. Dose adjustment or therapy change is individualized based on levels.
What happens
An increased risk of hyperkalemia
Interaction Deep Dive
When tacrolimus is taken together with ACE inhibitors, the likelihood of developing hyperkalemia may rise. Serum potassium should be checked at regular intervals throughout the course of therapy1.
Why it happens (mechanism)
Unknown
How to manage this interaction
This combination is manageable with routine monitoring. Your care team will likely check your potassium with periodic blood tests, especially early on or if your kidney function changes.
- Keep taking both tacrolimus and lisinopril exactly as prescribed unless your doctor tells you otherwise.
- If potassium runs high, your team may adjust a dose, individualized to you, or add closer monitoring.
- Tell your pharmacist before adding potassium supplements, salt substitutes (often high in potassium), or other blood pressure medicines.
- Report muscle weakness, numbness/tingling, or a fluttering or slow heartbeat promptly.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Tacrolimus and Lisinopril together?
Taking tacrolimus and lisinopril together can raise your blood potassium, so your care team will check it periodically. Keep taking both as prescribed and report symptoms like muscle weakness or an irregular heartbeat. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tacrolimus and Lisinopril 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 Lisinopril interaction managed?
This combination is manageable with routine monitoring. Your care team will likely check your potassium with periodic blood tests, especially early on or if your kidney function changes. Keep taking both tacrolimus and lisinopril exactly as prescribed unless your doctor tells you otherwise. If potassium runs high, your team may adjust a dose, individualized to you, or add closer monitoring. Tell y… 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.
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 Lisinopril 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)
- 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 Lisinopril
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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:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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