The short answer
Not known in people. We found no study of neem taken with tacrolimus, cyclosporine or other medicines that damp down the immune system. In lab tests, a neem extract blocked CYP3A4/5, liver enzymes that clear tacrolimus. When these enzymes are blocked, tacrolimus levels can rise.
Memorial Sloan Kettering's herb database says the clinical importance of the lab finding is not known. We found nothing on neem with azathioprine or mycophenolate. If you take an immunosuppressant, tell your transplant team or prescribing doctor before you start any neem product, and ask whether your drug level should be checked.
These are sold in India as Pangraf (tacrolimus), Panimun Bioral (cyclosporine), Azoran (azathioprine) and Mycept (mycophenolate).
At a glance
| What was seen | How it may work | Direction | Evidence |
|---|---|---|---|
| Neem extract blocked CYP3A4/5, CYP2C8 and CYP2C9 in lab tests[1][2] | Enzyme inhibition; tacrolimus is cleared by CYP3A | Possibly more tacrolimus in the blood | In vitro |
No listing is not a clearance. A missing interaction here never means a combination is safe.
The evidence, study by study
Laboratory finding, reported by Memorial Sloan Kettering In vitro
A neem extract blocked the liver enzymes CYP3A4/5, CYP2C8 and CYP2C9 in the lab. Memorial Sloan Kettering notes that the clinical relevance is not known. Lab findings like this show a possible route for an interaction. They do not show that one happens in people.[1]
What your doctor may watch for
- Tacrolimus trough level (the lowest level before the next dose) and kidney function, through your transplant team. The tacrolimus label recommends drug-level monitoring.[2]
What to tell your prescribing doctor
You can read this out, or show them this page:
“I am taking, or planning to take, neem (leaf powder, capsules, extract or juice, and how much) along with my transplant medicine. In lab tests neem blocked the enzymes that clear tacrolimus. Should my drug level be checked after I start or stop it?”
Withheld until review
Questions people ask
Is neem juice or neem oil the same as a neem extract?
No. Leaves, twigs, bark, extracts and oil are different products, and a lab result for one extract does not carry over to the others. Tell your transplant team exactly which form you use.[1]
Related
Neem and blood pressure medicines
Neem lowered blood pressure in rats, and in lab tests it blocked an enzyme that clears amlodipine. We found no study of neem with BP medicines.
InteractionPippali, black pepper and cyclosporine
Piperine from pepper raised cyclosporine absorption in rats and blocked its gut pump in lab cells. We found no study in people.
InteractionAshwagandha with steroids and transplant drugs
One kidney transplant patient on tacrolimus, mycophenolate and prednisone rejected and lost the kidney after taking ashwagandha.
InteractionGiloy with immunosuppressants and steroids
Not tested together. Giloy has been linked to autoimmune-like liver injury, which matters for people whose immune system is being treated.
Sources
- Memorial Sloan Kettering Cancer Center. About Herbs: Neem. Herb-drug interactions and warnings.
- Tacrolimus capsules, US prescribing information (DailyMed).
Awaiting review by The Good Vaidya Medical Board. Prepared from the sources below and checked against each one.
Published 4 November 2026 · Last updated 4 November 2026
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