Tacrolimus

For an informed discussion with your doctor or pharmacist. This information collection is not a clinically validated interaction checker. Missing data do not establish safety. Do not change or stop prescribed medicines on the basis of this information. The findings apply to the specific conditions studied; laboratory and animal studies cannot be directly extrapolated to humans.

Active substance: Tacrolimus

Examples of brand names: Prograf [DE]; Advagraf [EU]

ATC code: L04AD02

Main use (for orientation): Transplant medicine

Documented research summary

Direct evidence: CBD increased tacrolimus exposure in a controlled phase I study (n=12; AUC 3.1-fold, Cmax 4.2-fold), with additional case reports. A small transplant series showed variable blood concentrations, in some cases already elevated before CBD. Reports involving smoked cannabis are confounded and do not establish an isolated THC effect.

Uncertainties and limitations

Controlled study in healthy volunteers using a single tacrolimus dose; dose, preparation, genotype and the transplant setting limit generalisability. In-vitro inhibition of CYP3A5 by CBD supports, but does not alone establish, the complete mechanism in humans. Moadel/Chism 2019: the original abstract was read on Jefferson's institutional website; no numerical change in exposure was verified there.

Separately recorded findings

1 separately recorded finding. Each statement applies to its documented study context.

CBD – clinically studied

Finding ID: B0019

Type of result: Positive finding / indication

Observation: AUC 3.1-fold; Cmax 4.2-fold; half-life unchanged.

Mechanism: CYP3A / intestinal transport suspected

Study type: Open-label phase I crossover interim analysis

Context studied: 15 healthy participants enrolled, 14 completed, 12 in the main analysis (2 excluded because of sample quality); CBD 5 mg/kg twice daily after titration, tacrolimus 5 mg as a single dose without / with CBD.

Clinical interpretation: High: narrow therapeutic index

Limitations and uncertainties: Planned genotype-blinded interim analysis; no transplant recipients. Sensitivity analysis with n=14: Cmax GMR 3.27 and AUC0–∞ GMR 2.77. The relative contributions of the mechanisms and the effects of lower CBD doses remain unresolved.

Original sources for this finding: A Phase I Trial of the Pharmacokinetic Interaction Between Cannabidiol and Tacrolimus [CL07]

References and access status

[CA_L_D0019] TACROLIMUS (TACROLIMUS) CAPSULE [BIOCON PHARMA INC.]

Original source / bibliographic reference

Authors: Biocon Pharma Inc.

Year: 2026

Source type: Current published human-use SPL / product information

Source access – 23 October 2026: Source destination was accessible when checked.

Bibliographic attribution or source identity cross-checked.

[CL07] A Phase I Trial of the Pharmacokinetic Interaction Between Cannabidiol and Tacrolimus

Original source / bibliographic reference

Authors: So GC; Lu JBL; Koyama S; Cheng YH; Gisch DL; McClara K; Dexter PR; Sharfuddin AA; Etkins J; Tillman EM; Beamon TR; Cowsert Z; Stuart JS; Desta Z; Eadon MT

Year: 2025

Source type: Open-label phase I crossover study, interim analysis

DOI: 10.1002/cpt.3504

PMID: 39601108

Source access – 23 October 2026: Direct retrieval could not be fully verified; availability remains unresolved.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

PubMed Central – full-text access according to the literature database – Archive attribution confirmed by Europe PMC metadata. Direct retrieval was not fully verified here; access may require a browser check.

Europe PMC – full-text access according to the literature database – Listed as freely available HTML full text in the official Europe PMC metadata. Direct retrieval was not fully verified here.

[CA_P_31012522] Evidence of a clinically significant drug-drug interaction between cannabidiol and tacrolimus.

Original source / bibliographic reference

Authors: Leino AD, Emoto C, Fukuda T, Privitera M, Vinks AA, Alloway RR.

Year: 2019

Source type: Journal Article; Case Reports

DOI: 10.1111/ajt.15398

PMID: 31012522

Source access – 23 October 2026: Source destination was accessible when checked.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

[CA_P_29579828] Chronic Pain Treatment With Cannabidiol in Kidney Transplant Patients in Uruguay.

Original source / bibliographic reference

Authors: Cuñetti L, Manzo L, Peyraube R, Arnaiz J, Curi L, Orihuela S.

Year: 2018

Source type: Clinical Trial; Journal Article

DOI: 10.1016/j.transproceed.2017.12.042

PMID: 29579828

Source access – 23 October 2026: Source destination was accessible when checked.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

[CA_P_35990782] Late presentation of posterior reversible encephalopathy syndrome following liver transplantation in the setting of tacrolimus and cannabis use.

Original source / bibliographic reference

Authors: Zhou F, Costa AF, McLeod M.

Year: 2022

Source type: Journal Article; Case Reports; case-report

DOI: 10.3138/canlivj-2021-0017

PMID: 35990782

Source access – 23 October 2026: Automated direct retrieval was restricted; this does not establish that the link is broken.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

PubMed Central – full-text access according to the literature database – Archive attribution confirmed by Europe PMC metadata. Direct retrieval was not fully verified here; access may require a browser check.

Europe PMC – full-text access according to the literature database – Listed as freely available HTML full text in the official Europe PMC metadata. Direct retrieval was not fully verified here.

[CA_P_27595035] High on Cannabis and Calcineurin Inhibitors: A Word of Warning in an Era of Legalized Marijuana.

Original source / bibliographic reference

Authors: Hauser N, Sahai T, Richards R, Roberts T.

Year: 2016

Source type: research-article; Journal Article

DOI: 10.1155/2016/4028492

PMID: 27595035

Source access – 23 October 2026: Direct retrieval could not be fully verified; availability remains unresolved.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

PubMed Central – full-text access according to the literature database – Archive attribution confirmed by Europe PMC metadata. Direct retrieval was not fully verified here; access may require a browser check.

Europe PMC – full-text access according to the literature database – Listed as freely available HTML full text in the official Europe PMC metadata. Direct retrieval was not fully verified here.

[CA_P_39921332] Inhibition of Tacrolimus Metabolism by Cannabidiol and Its Metabolites In Vitro.

Original source / bibliographic reference

Authors: So GC, Lu JBL, Cheng YH, Gisch DL, Koyama S, Melo Ferreira R, Beamon TR, Desta Z, Eadon MT.

Year: 2025

Source type: research-article; Journal Article; Research Support, N.I.H., Extramural

DOI: 10.1111/cts.70152

PMID: 39921332

Source access – 23 October 2026: Source destination was accessible when checked.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

[CA_P_30819507] Medical Marijuana-Induced Tacrolimus Toxicity.

Original source / bibliographic reference

Authors: Moadel D, Chism K.

Year: 2019

Source type: Journal Article; Case Reports

DOI: 10.1016/j.psym.2019.01.009

PMID: 30819507

Source access – 23 October 2026: Direct retrieval could not be fully verified; availability remains unresolved.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

Research as of 23 October 2026. Not all original full texts could be reviewed in full. Source accessibility and the strength of scientific evidence must be assessed separately. An accessible link does not establish medical approval; a bibliographic record with an abstract does not replace the original full text.

Drug search and explanation of the evidence · Guide: cannabinoids and medicines · Author and responsibility