What the FDA labels say about taking them together
Tacrolimus and voriconazole
Tacrolimus's FDA label of July 17, 2026 names voriconazole in its drug interactions section, and voriconazole's label names tacrolimus too. The voriconazole label: “When initiating therapy with VFEND in patients already receiving tacrolimus, reduce the tacrolimus dose to one-third of the starting dose and follow with frequent monitoring of tacrolimus blood levels. …”
Check it at the source: the tacrolimus FDA label on DailyMed (effective July 17, 2026, Stellon Biotech Inc.); the voriconazole FDA label on DailyMed (effective February 26, 2026, Roerig).
What does the tacrolimus label say about voriconazole?
Tacrolimus label, drug interactionsDrug/Substance Class or Name: Strong CYP3A Inhibitors 3: Protease inhibitors (e.g, nelfinavir, telaprevir, boceprevir, ritonavir), azole antifungals (e.g., voriconazole, posaconazole, itraconazole, ketoconazole), antibiotics (e.g., clarithromycin, troleandomycin, chloramphenicol), nefazodone, letermovir, Schisandra sphenanthera extracts; Drug Interaction Effect: May increase tacrolimus whole blood trough concentrations and increase the risk of serious adverse reactions (e.g., neurotoxicity, QT prolongation). A rapid, sharp rise in tacrolimus levels may occur early, despite an immediate reduction of tacrolimus dose [see,,)].; …
Tacrolimus label, warnings and precautionsInhibitors and Inducers When co-administering tacrolimus with strong CYP3A4 inhibitors (e.g., telaprevir, boceprevir, ritonavir, ketoconazole, itraconazole, voriconazole, clarithromycin) and strong inducers (e.g., rifampin, rifabutin), adjustments in the dosing regimen of tacrolimus and subsequent frequent monitoring of tacrolimus whole blood trough concentrations and tacrolimus-associated adverse reactions are recommended.
Astagraf Xl label (Astellas Pharma US, Inc., January 14, 2026), warnings and precautionsTherefore, adjust ASTAGRAF XL dose and monitor tacrolimus whole blood trough concentrations when co-administering ASTAGRAF XL with strong CYP3A inhibitors (e.g., including, but not limited to, telaprevir, boceprevir, ritonavir, ketoconazole, itraconazole, voriconazole, clarithromycin) or strong CYP3A inducers (e.g., including, but not limited to, rifampin, rifabutin) [see Dosage and Administration ( 2.4 ) and Drug Interactions ( 7.2 )].
Source: FDA drug label (Prograf, NDA050708), Astellas Pharma US, Inc., effective August 25, 2023 (SPL set 7f667de1-9dfa-4bd6-8ba0-15ee2d78873b), via openFDA
Source: FDA drug label (Tacrolimus), Stellon Biotech Inc., effective July 17, 2026 (SPL set 6b89e8a4-9f11-42e3-8e79-fe617e7c461f), via openFDA; the full label on DailyMed
What does the voriconazole label say about tacrolimus?
Voriconazole label, drug interactionsDrug/Drug Class (Mechanism of Interaction by Voriconazole): Tacrolimus (CYP3A4 Inhibition); Drug Plasma Exposure (C max and AUC τ): Significantly Increased; Prevention or Management Recommendations: When initiating therapy with VFEND in patients already receiving tacrolimus, reduce the tacrolimus dose to one-third of the starting dose and follow with frequent monitoring of tacrolimus blood levels. Increased tacrolimus levels have been associated with nephrotoxicity. When VFEND is discontinued, tacrolimus concentrations must be frequently monitored and the dose increased as necessary.
Source: FDA drug label (Voriconazole, NDA208562), Xellia Pharmaceuticals USA LLC, effective January 11, 2023 (SPL set 9ec6eda2-2f15-423b-9ec6-819379a426e1), via openFDA
Source: FDA drug label (VFEND), NDA021630 (Pf Prism Cv), as published by Roerig, effective February 26, 2026 (SPL set ce3ef5cf-3087-4d92-9d94-9eb8287228db), via openFDA; the full label on DailyMed
These are the labels' own sentences. PlainMeds does not grade interactions; a pharmacist or prescriber can say what they mean for one person's medicines.
Both medicines on the record
| Tacrolimus | Voriconazole | |
|---|---|---|
| Labeled for | Organ transplant rejection, Eczema (atopic dermatitis) | Fungal infections |
| Boxed warning | Yes | No |
| Pharmacy cost (NADAC) | $0.970 per gram 0.1% ointment | $1.88 per tablet 200 mg tablet |
| Shortage now | No current entry | A presentation being discontinued |
Source: FDA NDC Directory, CMS NADAC of October 7, 2026 and the FDA Drug Shortage Database (FDA files October 8, 2026)
What next?
- Check more medicines together
- up to five at once