tacrolimus, Prograf (cont.)

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Medical and Pharmacy Editor:

Other drugs can stimulate the break-down of tacrolimus, decreasing its blood concentration and possibly reducing its effectiveness. Such drugs include carbamazepine (Tegretol), nifedipine (Procardia; Adalat); phenobarbital, phenytoin (Dilantin), St. John's Wort, rifabutin, and rifampin.

Live virus vaccines should be avoided while receiving tacrolimus or any other medicine that suppresses the immune system since the vaccines may be less effective. Since tacrolimus can cause hyperkalemia (high potassium in the blood), the use of tacrolimus with diuretics that also cause retention of potassium is not recommended. Such diuretics include triamterene (found in Dyazide and Maxzide), amiloride (found in Moduretic), and spironolactone (Aldactone). Magnesium or aluminum hydroxide containing antacids bind tacrolimus in the stomach and prevent its absorption into the body. Magnesium or aluminum-containing antacids should not be taken with tacrolimus.

PREGNANCY: Tacrolimus crosses the placenta, but there have been no adequate studies in pregnant women to assess the effects on the fetus. Among women who have received tacrolimus while pregnant, high potassium levels and kidney injury in newborns have been reported. Therefore, tacrolimus should be used during pregnancy only when it is clearly needed.

NURSING MOTHERS: Tacrolimus passes into breast milk. It is recommended that breastfeeding be discontinued while women are receiving oral tacrolimus.

SIDE EFFECTS: Tacrolimus is associated with many and various side effects. These include baldness, anemia, loss of appetite, diarrhea, high concentrations of potassium in the blood, high blood pressure, nausea, vomiting, tingling sensation in the extremities, itching, tremor, fever, headache, rash, high blood sugar concentrations, and abdominal pain. Other side effects include confusion, painful joints, increased sensitivity to light, blurred vision, insomnia, infection, jaundice (yellowing of the skin due to effects on the liver), kidney injury, swollen ankles, and seizures.

Reference: FDA Prescribing Information

Last Editorial Review: 4/26/2012

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