Is Echinacea Safe with Tacrolimus?
Free · No account · based on published sources including NIH ODS, FDA drug labels, and peer-reviewed literature
Do NOT take echinacea if you are on tacrolimus. This combination poses a serious risk of acute organ rejection in transplant recipients. Inform your transplant team immediately if you have taken echinacea.
Why this interaction occurs
Tacrolimus is used primarily to prevent organ rejection by suppressing T-cell-mediated immune responses via calcineurin inhibition. Echinacea's immunostimulatory properties—including T-cell activation and cytokine upregulation—directly antagonize this mechanism and may precipitate acute allograft rejection. Some evidence also suggests echinacea may affect CYP3A4 and P-glycoprotein, potentially altering tacrolimus pharmacokinetics.
Evidence
Evidence level: moderate.
Data source
PubMed: PMID 37857794, PMID 19719333
Reported safety data
The FDA’s adverse event reporting system (FAERS) has received 130,929 reports mentioning Tacrolimus. This reflects reported cases involving the medication in general — not confirmed causation, and not specific to the Tacrolimus + supplement combination on this page.
FAERS reports are voluntary and cannot prove that a drug caused an event. Do not use report counts to assess the safety of this specific drug-supplement pair.
Frequently asked questions
Related interactions
All Echinacea interactions → · All Tacrolimus interactions →
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Educational only — not medical advice.
Always confirm with your doctor or pharmacist.