Tacrolimus (Prograf) and Ketamine Therapy | Tovani Health
Prograf (Tacrolimus) (also: Astagraf XL, Envarsus XR, Protopic (topical)) — Calcineurin inhibitor (transplant immunosuppressant)
Verdict at Tovani Health
Fully compatible; the real concern is third-party CYP3A4 modulators, not ketamine itself.
Tacrolimus and ketamine have no direct clinically significant interaction. Tacrolimus is a narrow-therapeutic-index CYP3A4 substrate, which sounds alarming — but ketamine is also a CYP3A4 substrate without inhibitor or inducer activity, so the substrate-substrate combination doesn't shift either drug's level. The real interaction concern with tacrolimus is third-party drugs in the stack: strong CYP3A4 inhibitors (clarithromycin, fluconazole, Paxlovid, grapefruit) raise tacrolimus toxicity, and CYP3A4 inducers (rifampin, phenytoin, carbamazepine) drop it to rejection-risk levels. Those conversations apply to tacrolimus independent of KAP. Topical tacrolimus (Protopic) for eczema has even less systemic exposure.
If you take Prograf regularly and are considering at-home ketamine therapy, the combination is generally safe at therapeutic doses. This page covers the brief pharmacologic context and what we do at intake.
How Prograf interacts with ketamine
Tacrolimus inhibits calcineurin in T cells, blocking IL-2 transcription. Substrate of CYP3A4 and P-glycoprotein; narrow therapeutic index. Ketamine is also a CYP3A4 substrate but neither inhibits nor induces CYP3A4 — no reciprocal level shift.
What we do at intake
Continue as prescribed. Tell us your last trough level if you know it, and disclose your full transplant regimen including any antifungals and antibiotics.
Bottom line
Tacrolimus and ketamine have no direct clinically significant interaction. Tacrolimus is a narrow-therapeutic-index CYP3A4 substrate, which sounds alarming — but ketamine is also a CYP3A4 substrate without inhibitor or inducer activity, so the substrate-substrate combination doesn't shift either drug's level. The real interaction concern with tacrolimus is third-party drugs in the stack: strong CYP3A4 inhibitors (clarithromycin, fluconazole, Paxlovid, grapefruit) raise tacrolimus toxicity, and CYP3A4 inducers (rifampin, phenytoin, carbamazepine) drop it to rejection-risk levels. Those conversations apply to tacrolimus independent of KAP. Topical tacrolimus (Protopic) for eczema has even less systemic exposure.
Ready to find out if at-home ketamine fits your situation?
We’ll note that you’re on Prograf (Tacrolimus) at intake. The eligibility check takes 5 minutes and gives you an honest answer about whether at-home ketamine fits your specific situation.
FL and NJ residents only. Benjamin Soffer, DO — Tovani Health.
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 22, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.