Tacrolimus

What is tacrolimus?

Tacrolimus works by preventing your body from rejecting your new organ. It is called an immunosuppressant or an anti-rejection medication.

What tacrolimus looks like

Tacrolimus can come in a capsule or liquid. Here are some examples of one brand of the regular-acting tacrolimus (Prograf®) and the long-acting (extended release) tacrolimus (Advagraf®) used after a transplant.

Note: These photos are close-ups of the capsules; they are not to scale.

If you cannot swallow the capsules, your hospital or local pharmacy may also make up tacrolimus suspension (liquid).

How to take tacrolimus

• Wash your hands before and after handling tacrolimus.
• Take tacrolimus at the same times every day.
• If you are on regular-acting tacrolimus (Prograf®) capsules or the tacrolimus suspension (liquid), take your dose every 12* hours. *Your transplant team will tell you if you need to take it more often, such as every 8 hours.
• If you are on the long-acting (extended release) tacrolimus (Advagraf®), take your dose once a day in the morning.
• You can take tacrolimus with food or without food, but take it the same way every day. Changes in your food intake can affect how much tacrolimus passes from your stomach into your blood.
  
• Take tacrolimus with the same type of drink each day, but avoid grapefruit juice, even if it is mixed with other fruit juices. Grapefruit raises the tacrolimus levels in your blood, which can lead to more side effects. Also, never eat pomelos, tangelos or any other fruit that is a hybrid (mix) of grapefruit and another fruit. Always read food labels carefully to ensure there is no grapefruit in a product.
• You may be prescribed one brand of tacrolimus right after transplant and another brand at a later time. Make sure you always take the same brand until your transplant team tells you change it. Discuss this with your community pharmacist so that you always receive the same brand when you refill your prescription.
• Call your transplant team if you notice that the tacrolimus capsules look different from what you normally take.

Taking tacrolimus capsules

• Swallow tacrolimus capsules whole.
• Do not open the capsules unless the transplant team has told you to do so.

Taking tacrolimus suspension (liquid)

• Shake the bottle well before measuring each dose.
• Measure the dose in the syringe provided. Wash away any liquid left on your hands right after you take your dose. Rinse the syringe and let it air dry. Use the same syringe for tacrolimus every day.

Possible side effects of tacrolimus

• Mild headache
• Low magnesium levels in the blood
• High potassium levels in the blood
• High blood sugar (some teens develop diabetes)
• High blood pressure
• Damage to the kidneys
• Shakiness (tremor) of the hands or feet
• Nausea (upset stomach), vomiting (throwing up)
• Diarrhea (watery stools)
• Seizures (if blood levels of tacrolimus are too high)
• Leg cramps
• Hair loss in patches, although this is rare
• Greater risk of developing infection

How to store tacrolimus

• Keep tacrolimus out of reach of any small children.
• Keep it at room temperature in a cool, dry place away from sunlight.
• Never store it in the bathroom or near sources of heat in the kitchen.
• Never store it in the refrigerator or freezer.

Tacrolimus suspension (liquid)

• Always store it in its original glass bottle. Tacrolimus suspension is stable only for a certain amount of time. Check the label for the expiry date.