Tacrolimus and Nifedipine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Tacrolimus
Nifedipine
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 toxicity
Interaction Deep Dive
Tacrolimus is primarily metabolized by the CYP3A hepatic enzyme systems. Coadministration with NIFEdipine has resulted in increased tacrolimus blood levels due to the competitive inhibition of CYP3A-mediated tacrolimus metabolism4. Concomitant administration of NIFEdipine and tacrolimus may increase tacrolimus whole blood trough concentrations and increase the risk of serious adverse reactions (including neurotoxicity or QT prolongation). If NIFEdipine and tacrolimus are used concurrently, monitor tacrolimus levels, reduce the dose as needed, and monitor for tacrolimus-associated adverse effects 12.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated tacrolimus metabolism
Literature reports
2 reports — tap to read
a) Concomitant use of tacrolimus and NIFEdipine significantly increased mean trough concentration/dose ratio of tacrolimus in adult transplant patients (N=10) compared with tacrolimus use alone (2.6 vs 1.5) in a prospective study. The mean trough concentration of tacrolimus significantly increased with concomitant use (14.4 vs 12.9 nanograms/mL), despite a significantly lower mean daily dose (7.8 vs 9.5 mg), compared to tacrolimus use alone. In addition, gingival hyperplasia occurred 7 and 16 days after beginning concomitant use of NIFEdipine and tacrolimus in 2 kidney transplant patients. Monitoring of therapeutic immunosuppressant concentrations and dosage reduction should be considered with concomitant use 3.
b) The possible interaction between NIFEdipine and tacrolimus was evaluated in a retrospective study of 50 liver transplant recipients. Of the 50 patients, 22 were hypertensive patients treated with NIFEdipine; the other 28 did not receive NIFEdipine. All patients also received immunosuppressive therapy with tacrolimus. Data from the two patient groups were obtained from medical records, and consisted of tacrolimus dosages, cumulative dosages, tacrolimus serum concentrations, and cumulative prednisone dosages. Absolute tacrolimus daily dosages in the NIFEdipine group were significantly lower than for the non-NIFEdipine group after 90 days (26.2% lower), 6 months (29.8% lower), and 12 months (38.1% lower) of tacrolimus therapy. The cumulative dosages of tacrolimus were also significantly lower for the NIFEdipine group after 6 months and 12 months of therapy, with a 25.5% and 31.4% lower tacrolimus dose, respectively. Tacrolimus blood concentrations in the NIFEdipine group were 55% higher after 30 days of therapy, with a average concentration of 13.8 nanograms/milliliter (ng/mL; 17.2 nanomol/L) compared to 8.9 ng/mL (11.1 nanomol/L) for the non-NIFEdipine group. Tacrolimus serum concentrations were not significantly different, indicating that dosage adjustments were made to keep tacrolimus concentrations within the therapeutic range. This drug interaction may be related to competitive inhibition of cytochrome P450 isoenzymes involved in the metabolism of tacrolimus by NIFEdipine. Tacrolimus concentrations should be closely monitored, and appropriate dosage adjustments made when NIFEdipine is added to or removed from therapy 4.
Common questions
Can I take Tacrolimus and Nifedipine together?
Increased tacrolimus exposure and an increased risk of toxicity Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tacrolimus and Nifedipine 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.
Questions for your pharmacist
- Does my dose of Tacrolimus or Nifedipine 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: 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
- Gago-Sanchez AI, Font P, Cardenas M, et al: Real clinical impact of drug-drug interactions of immunosuppressants in transplant patients. Pharmacol Res Perspect 2021; 9(6):e00892.
- Seifeldin RA, Marcos-Alvarez A, Gordon FD, et al: Nifedipine interaction with tacrolimus in liver transplant recipients. Ann Pharmacother 1997; 31:571-575. PubMed
Keep reading about Tacrolimus
Keep reading about Nifedipine
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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