tacrolimus, Prograf, Astagraf XL, Hectoria

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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PREPARATIONS: Capsule: 0.5, 1, and 5 mg. Injection: 5 mg/ml

STORAGE: Tacrolimus should be stored at room temperature between 15 C - 30 C (59 F - 86 F).

DOSING: Oral tacrolimus is taken twice daily. Starting doses range between 0.075 mg/kg/day to 0.2 mg/kg/day. Doses vary widely and are based on tests that measure the amount of tacrolimus in the blood. Taking tacrolimus with food can reduce some of the abdominal pain that can occur with this medicine; however, food can reduce the amount of tacrolimus that is absorbed. This is especially true with fatty foods. Capsules should be taken consistently with or without food in order to avoid major swings in blood levels. Grapefruit juice increases blood levels of tacrolimus and should be avoided. The injection is only used for patients who cannot tolerate tacrolimus capsules.

DRUG INTERACTIONS: The destruction of tacrolimus by the body may be inhibited by a large number of drugs, resulting in higher blood levels of tacrolimus and possibly increasing its side effects. Such drugs include lansoprazole (Prevacid), omeprazole (Prilosec), protease inhibitors (for example, nelfinavir [Viracept] and ritonavir [Norvir]), bromocriptine (Parlodel), cimetidine (Tagamet), cisapride (Propulsid), clarithromycin (Biaxin), cyclosporine (Sandimmune; Neoral), danazol (Danocrine), diltiazem (Cardizem, Tiazac), erythromycin, fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), metoclopramide (Reglan), methylprednisolone (Medrol), nicardipine (Cardene), troleandomycin (Tao), and verapamil (Calan, Isoptin, Verelan, Covera-HS). Grapefruit juice has a similar effect on tacrolimus and should be avoided.

Medically Reviewed by a Doctor on 2/17/2015

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