- Oral tacrolimus is taken twice daily.
- Starting doses range between 0.075 mg/kg/day to 0.2 mg/kg/day (immediate release capsules).
- 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.
- 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.
- 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.
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