Tacrolimus and Metoclopramide Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Tacrolimus
Metoclopramide 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
Increased tacrolimus exposure and an increased risk of tacrolimus toxicity
Interaction Deep Dive
Concomitant use of metoclopramide and tacrolimus may result in increased tacrolimus exposure due to enhanced gastrointestinal motility by metoclopramide1. Concomitant use of tacrolimus with metoclopramide 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 23. Tacrolimus toxicity (nephrotoxicity, neurotoxicity, hyperkalemia) has occurred, as described in a case report 4.
Why it happens (mechanism)
Increased absorption of tacrolimus due to enhanced gastrointestinal motility by metoclopramide
Literature reports
1 report — tap to read
a) Coadministration of metoclopramide with tacrolimus significantly increased tacrolimus bioavailability, provoking acute tacrolimus toxicity. As described in a case report, a 52-year-old woman initially experienced subtherapeutic tacrolimus serum concentrations despite escalating doses of tacrolimus (from 7 to 28 mg twice daily) in the presence of potent inhibitors of tacrolimus metabolism (ketoconazole, cimetidine). Prior to beginning treatment with metoclopramide 10 mg 4 times daily, her tacrolimus serum concentrations remained below the lower limit of detection. Tacrolimus trough serum concentrations began trending upwards after 5 days of metoclopramide therapy (to 5.6 nanograms/mL (19 nanomol/L)); within 1 day of increasing metoclopramide to 20 mg 4 times daily, tacrolimus trough serum concentrations measured at greater than 30 nanograms/mL (40 nanomol/L), provoking signs and symptoms of tacrolimus renal toxicity. Ketoconazole was discontinued while tacrolimus was temporarily discontinued for 4 days, after which tacrolimus was reintroduced at 4 mg twice daily. Metoclopramide was discontinued soon thereafter, with the patient stabilized on a tacrolimus dose regimen of 1 mg twice daily. The Naranjo probability score for this drug interaction was rated as 5 (probable) 4.
Common questions
Can I take Tacrolimus and Metoclopramide Injection together?
Increased tacrolimus exposure and an increased risk of tacrolimus toxicity Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tacrolimus and Metoclopramide 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 "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Tacrolimus or Metoclopramide 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 (4)
- Product Information: REGLAN(R) oral tablets, metoclopramide oral tablets. ANI Pharmaceuticals, Inc. (per FDA), Baudette, MN, 2017. DailyMed
- 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
- Prescott WA, Callahan BL, & Park JM: Tacrolimus toxicity associated with concomitant metoclopramide therapy. Pharmacotherapy 2004; 24(4):532-537. PubMed
Keep reading about Tacrolimus
Keep reading about Metoclopramide Injection
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.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist