Prograf, Astagraf XL, Envarsus XR

GENERIC AVAILABLE: Yes

Yes

• Tacrolimus is used for the prevention of rejection of transplanted kidneys, liver, or heart.
• It can be combined with steroids, azathioprine (Imuran Azasan) or mycophenolate mofetil (CellCept).

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.

• 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.

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

What preparations of tacrolimus are available?

• Capsule: 0.5, 1, and 5 mg
• Tablets: 0.75, 1, 4 mg
• Injection: 5 mg/ml

How should I keep tacrolimus stored?

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