Drug & supplement interaction

Astragalus + Tacrolimus

Tacrolimus brand names: Prograf (capsule), Prograf (injectable), Protopic, Prograf XL, Astagraf XL, and others.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Astragalus has a moderate interaction with Tacrolimus. Theoretically, astragalus might interfere with immunosuppressive therapy.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Astragalus and Tacrolimus

Here is the interaction we found between these two, with the evidence behind it.

Moderate

IMMUNOSUPPRESSANTS

Why this applies to Tacrolimus

Tacrolimus falls under IMMUNOSUPPRESSANTS — the group Astragalus interacts with.

Theoretically, astragalus might interfere with immunosuppressive therapy.
Astragalus seems to stimulate immune function. Theoretically, taking astragalus might decrease the effects of immunosuppressive therapy.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the concern with pairing these two. Tacrolimus has one job after a transplant: to quiet down your immune system so your body doesn't attack the new organ. Astragalus, on the other hand, is traditionally used to do the opposite, it's thought to rev up immune activity. So in theory, the two could work against each other, and astragalus might chip away at how well your tacrolimus protects your transplant.

I want to be honest about the evidence here: this is based on lab and animal studies, not real-world transplant patients, so it's more of a caution than a proven problem. But because tacrolimus is a narrow-margin drug where even small shifts matter, and organ rejection is a serious risk, I'd play it safe. Please check with your transplant team or pharmacist before adding astragalus.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Upton R, ed. Astragalus Root: Analytical, quality control, and therapeutic monograph. Santa Cruz, CA: American Herbal Pharmacopoeia. 1999:1-25.
  2. Sun Y, Hersh EM, Lee SL, et al. Preliminary observations on the effects of the Chinese medicinal herbs Astragalus membranaceus and Ligustrum lucidum on lymphocyte blastogenic responses. J Biol Response Mod 1983;2:227-37..

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Astragalus Also Interacts With Other Medications

Astragalus has 207 moderate known drug interactions in our database — the Tacrolimus one above is one of them. If you take anything else, check it against the full list below.

Moderate 207 No known interaction 2,623 (incl. Tacrolimus)
Taking anything else?

Check Another of Your Medications Against Astragalus

Covers the 2,830 medications we’ve checked against Astragalus. Pick one to open its full report.

From our Q&A

Questions About Astragalus or Tacrolimus

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Astragalus or Tacrolimus, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Tacrolimus

This page covers Astragalus only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Tacrolimus page lists 202 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), Arsenic (major), Asarabacca (major) and Cesium (major).

By severity: 11 major · 152 moderate · 39 minor.

From our pharmacist’s overview on the Tacrolimus page

“Tacrolimus (Prograf, Astagraf XL, Envarsus XR) keeps a transplanted organ from being rejected, and it works inside a narrow blood-level window, meaning even small shifts can invite rejection or toxicity. That makes these 202 supplement interactions worth real caution.”

Reviewed by 2 · Jul 18, 2026

Open the Tacrolimus interaction page

One more smart check

Taking Astragalus as Part of a Dietary Supplement Product? Check It for Interactions

We hold 3,437 real supplement products containing Astragalus, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Astragalus. Your product may carry other ingredients that interact with Tacrolimus too, on top of Astragalus — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Astragalus and Tacrolimus Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Astragalus
Top 5%

#73 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Tacrolimus
Top 25%

#398 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Astragalus

What is Astragalus?

Astragalus
  • Immune support
  • Colds and flu
  • Upper respiratory infections
  • Fatigue and stress (adaptogen)
  • Heart health
  • General wellness in traditional medicine

Astragalus is a root used for centuries in traditional Chinese medicine, mainly to support the immune system and help the body cope with stress. While early studies are interesting, strong human evidence for most uses is still lacking. It is generally well tolerated by healthy adults for short-term use, but should be avoided during pregnancy and breastfeeding due to limited safety data.

Read the full Astragalus monograph & all interactions
Medication

About Tacrolimus

What Is Tacrolimus Used For?

Brand names: Prograf (capsule), Prograf (injectable), Protopic, Prograf XL, Astagraf XL, Envarsus XR

Tacrolimus is prescribed to help prevent your body from rejecting a transplanted organ. It is used in adults who receive a kidney, liver, or heart transplant, and in children who receive a liver transplant. It is always used alongside other anti-rejection medicines.

Because tacrolimus works by dampening your immune system, it lowers the risk of your body attacking the new organ — but it also means you need to be watched closely for infections and other side effects throughout your treatment.

See full Tacrolimus drug information
Keep checking

Other Drugs & Astragalus

Browse every other medication we’ve checked against Astragalus — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
207Moderate
0Minor
2,622No known interaction
207 Moderate 2,622 No interaction
Moderate

207 interactions

Showing 60 of 207 moderate interactions — see all 207 on the Astragalus page.

No interaction 2,622 drugs checked — show the list

We also checked Astragalus against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,622 medications checked with no known interaction — see the full Astragalus list.

See the full Astragalus interactions page
See every supplement checked against Tacrolimus, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Astragalus monograph › Uses, safety, and every drug interaction in one place Tacrolimus supplement interactions › Every supplement checked against Tacrolimus, ranked by severity Tacrolimus drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Astragalus and Tacrolimus Together: Common Questions

Can you take Astragalus with Tacrolimus?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Astragalus and Tacrolimus interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Tacrolimus and Astragalus?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.