Drug & supplement interaction

Chokeberry + 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

Chokeberry has a moderate interaction with Tacrolimus. Theoretically, chokeberry might increase levels of drugs metabolized by CYP3A4.

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

Chokeberry and Tacrolimus

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

Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Why this applies to Tacrolimus

Tacrolimus falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group Chokeberry interacts with.

Theoretically, chokeberry might increase levels of drugs metabolized by CYP3A4.
In vitro research shows that chokeberry inhibits CYP3A4. In humans, there is one case report of a drug interaction with trabectedin, a CYP3A4 substrate, which is hypothesized to have been caused by chokeberry inhibition of CYP3A4.
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 gist: your body clears tacrolimus using a liver enzyme called CYP3A4. Lab studies suggest chokeberry may slow that same enzyme down. If that happens in real life, tacrolimus could clear more slowly and build up in your blood. Since tacrolimus is a narrow therapeutic index drug, even small shifts in its level matter, and higher levels can mean more side effects like kidney strain, tremor, headache, high blood pressure, or raised blood sugar.

Now, the honest part: this is mostly theory plus one case report with a different drug, so it's far from proven. A little chokeberry in food likely won't do much, but concentrated juice or supplements are a bigger question. Please check with your transplant team or pharmacist before adding it, since they can monitor your levels.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Bräunlich M, Christensen H, Johannesen S, Slimestad R, Wangensteen H, Malterud KE, Barsett H. In vitro inhibition of cytochrome P450 3A4 by Aronia melanocarpa constituents. Planta Med. 2013 Jan;79(2):137-41. PubMed
  2. Strippoli S, Lorusso V, Albano A, Guida M. Herbal-drug interaction induced rhabdomyolysis in a liposarcoma patient receiving trabectedin. BMC Complement Altern Med. 2013 Jul 30;13:199. PubMed

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

Chokeberry Also Interacts With Other Medications

Chokeberry has 810 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 810 No known interaction 2,020 (incl. Tacrolimus)
Taking anything else?

Check Another of Your Medications Against Chokeberry

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

From our Q&A

Questions About Chokeberry 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 Chokeberry 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 Chokeberry 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 Chokeberry as Part of a Dietary Supplement Product? Check It for Interactions

We hold 493 real supplement products containing Chokeberry, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Chokeberry. Your product may carry other ingredients that interact with Tacrolimus too, on top of Chokeberry — 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 Chokeberry 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 Chokeberry
Top half

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

29 days ago today
Medication Tacrolimus
Top 10%

#153 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 Chokeberry

What is Chokeberry?

Chokeberry
  • Antioxidant support
  • Heart and blood vessel health
  • Blood pressure support
  • Blood sugar support
  • Common cold symptoms
  • Anti-inflammatory support

Chokeberry (aronia) is a dark berry rich in antioxidants called polyphenols, and it's widely eaten as juice, jam, and supplements. Early research hints it may support heart health, blood pressure, and blood sugar, but the evidence is still limited and far from proven. It's generally well tolerated as a food, but talk to your pharmacist or doctor before using concentrated supplements.

Read the full Chokeberry 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 & Chokeberry

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

0Major
810Moderate
0Minor
2,019No known interaction
810 Moderate 2,019 No interaction
Moderate

810 interactions

Showing 60 of 810 moderate interactions — see all 810 on the Chokeberry page.

No interaction 2,019 drugs checked — show the list

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

Showing the 60 most looked-up of 2,019 medications checked with no known interaction — see the full Chokeberry list.

See the full Chokeberry 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
Chokeberry 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 Chokeberry and Tacrolimus Together: Common Questions

Can you take Chokeberry 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 Chokeberry 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 Chokeberry?

Our pharmacists answer your medication & supplement questions — free.

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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.