The short answer
Do not add a Schisandra chinensis supplement without advice from your transplant team. An interaction is plausible, but the well-known tacrolimus studies mainly used Schisandra sphenanthera, a different species. They do not establish the size or certainty of an effect from S. chinensis.
What this answer covers
Schisandra chinensis and Schisandra sphenanthera are distinct species. Wuzhi products studied with tacrolimus commonly contain S. sphenanthera extract; neither a shared common name nor a similar constituent makes the extracts interchangeable.
- Supplement or preparation
- Schisandra chinensis
- Medication ingredient
- tacrolimus
Which species raised tacrolimus in the study?
In a small healthy-volunteer study, S. sphenanthera extract substantially increased tacrolimus exposure after thirteen days of use. The tacrolimus product information also specifically names S. sphenanthera. Those findings should not be presented as a direct human trial of S. chinensis.
Is there any reason to be cautious with S. chinensis?
Yes. In humans, an S. chinensis extract changed exposure to a medicine used to test P-glycoprotein transport. Tacrolimus also depends on this transport system, which makes an interaction plausible. The study used talinolol, however, and cannot predict a tacrolimus blood-level change.
Have kidney injury or infections been established?
The inspected studies do not establish these outcomes from the exact S. chinensis-tacrolimus combination. Excess tacrolimus can cause harm, so an uncertain interaction deserves attention. That clinical concern should not be confused with proof that this specific plant causes kidney injury or infection.
What should I check before using a product?
Bring the label showing the Latin species, plant part, extract and dose to your transplant pharmacist. A product called only schisandra or Wuzhi may not identify the same exposure discussed here. Do not use an extract to boost tacrolimus or reduce its dose yourself; any such plan requires specialist oversight and blood-level monitoring.
Evidence and practical considerations
Absorption & effectiveness
Human tacrolimus studies and label warnings for S. sphenanthera do not confirm the exact S. chinensis pair; a human transport-probe study supplies mechanistic concern only.
- Exact scope
- Exact S. chinensis; explicitly excludes automatic transfer from Wuzhi/S. sphenanthera. with Tacrolimus, exact RxCUI 42316, inventory name tacrolimus, TTY IN. Oral systemic tacrolimus only. The US PROGRAF label describes tacrolimus capsules and anhydrous-equivalent strength; the UK capsule SmPC section 2 explicitly states tacrolimus as monohydrate. This bridges labeled monohydrate capsules to the IN, without merging different release formulations or transferring exposure results to topical or intravenous tacrolimus. No cyclosporine or other immunosuppressant evidence is substituted for tacrolimus evidence.
- Medication form and route
- oral
What remains uncertain
- Species, preparation and probe-drug boundaries prevent a direct-pair effect estimate.
Read the supporting source summaries
Source 1: original human clinical study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Twelve healthy male volunteers.
Mean individual percentage increases were 164.2% for total exposure and 227.1% for peak tacrolimus concentration.
How this applies: An explicitly excluded species bridge: useful to explain why Wuzhi/S. sphenanthera claims cannot be silently relabeled as S. chinensis.
Different plant species from S. chinensis. Small healthy-volunteer study, extract-specific, with no demonstrated kidney-injury or infection endpoint. Percentage summaries should not be confused with ratios of group means.
Source 2: original human clinical study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Twelve healthy male volunteers.
Talinolol 24-hour exposure rose 47% (90% CI 18%-84%) and peak concentration 51%, consistent with inhibited P-glycoprotein transport.
How this applies: Exact-species human mechanistic concern only, linked by tacrolimus being a P-glycoprotein substrate. This is not direct-pair clinical confirmation.
No tacrolimus was administered. Transport-probe effects cannot predict the size or clinical consequences of a tacrolimus interaction. Extract composition may differ from retail products.
Source 3: regulatory product information
medicines.org.uk · Source check Sep 10, 2026
Population: Systemic oral tacrolimus users, principally transplant recipients.
Advises avoiding St. John's wort and high potassium intake. Names Schisandra sphenanthera extracts, not S. chinensis, among exposure-raising interactions. Monitor levels around interacting-product changes.
How this applies: Explicit monohydrate-to-IN identity bridge. Supports named-product precautions and monitoring without borrowing another drug's results.
Regulatory guidance, not an exact-product randomized outcome trial. Species-specific warning cannot establish a measured S. chinensis effect.
Research assessment: · Open full citations ↗
Side effects & toxicity
Kidney injury and infection from S. chinensis with tacrolimus remain unestablished in inspected original evidence.
- Exact scope
- Oral S. chinensis products with verified species identity. with Tacrolimus, exact RxCUI 42316, inventory name tacrolimus, TTY IN. Oral systemic tacrolimus only. The US PROGRAF label describes tacrolimus capsules and anhydrous-equivalent strength; the UK capsule SmPC section 2 explicitly states tacrolimus as monohydrate. This bridges labeled monohydrate capsules to the IN, without merging different release formulations or transferring exposure results to topical or intravenous tacrolimus. No cyclosporine or other immunosuppressant evidence is substituted for tacrolimus evidence.
- Medication form and route
- oral
What remains uncertain
- Medication toxicity context is not a measured botanical pair outcome.
Read the supporting source summaries
Source 1: regulatory prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Patients receiving systemic tacrolimus for transplant immunosuppression; oral capsules and granules discussed separately from injection.
Requires drug-level monitoring and individualized dosing. Warns of nephrotoxicity, infections, neurotoxicity, QT prolongation and hyperkalemia. Avoid grapefruit and juice; CBD needs close monitoring and possible dose reduction.
How this applies: Medication-specific safety and monitoring context. Additional supplement-specific findings and explicit formulation boundaries are required.
Label warnings do not quantify the added clinical-event risk from each supplement. The oral products are not freely interchangeable; topical use is outside these data.
Source 2: original human clinical study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Twelve healthy male volunteers.
Talinolol 24-hour exposure rose 47% (90% CI 18%-84%) and peak concentration 51%, consistent with inhibited P-glycoprotein transport.
How this applies: Exact-species human mechanistic concern only, linked by tacrolimus being a P-glycoprotein substrate. This is not direct-pair clinical confirmation.
No tacrolimus was administered. Transport-probe effects cannot predict the size or clinical consequences of a tacrolimus interaction. Extract composition may differ from retail products.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Original evidence and current product information inspected; article distinguishes observed results, product limits and remaining uncertainty. | |
| Research summary published |
Article revision: 1ec333da94736a9e
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.