Tacrolimus

What is tacrolimus?

Tacrolimus (also called Prograf^®) is a medicine that suppresses the immune system. It is used to decrease the body’s natural immune response and prevent or treat graft-versus-host disease (GVHD) in bone marrow transplant patients. Tacrolimus is available as 0.5 mg, 1 mg, and 5 mg capsules, and the pharmacy makes an oral suspension (liquid). All are taken by mouth. Tacrolimus is also available as a clear liquid given by vein (IV).

Possible side effects of tacrolimus

Early

• Nausea and vomiting

Later (usually more than a day after treatment starts)

• Decreased kidney function
• Decreased liver function
• High blood pressure
• Headache
• Increased risk of infection
• Stomach pain
• Trouble sleeping
• Shaking and tremors
• Vision changes
• Seizures
• Low blood magnesium levels
• High blood potassium levels
• High glucose levels

These are the most common side effects, but there may be others. Please report all side effects to the doctor or nurse. In case of a severe side effect or reaction, call 595-3300. If you are outside the Memphis area, dial toll-free 1-866-2STJUDE (1-866-278-5833), and press 0 when the call connects.

Special instructions for tacrolimus

• Tacrolimus should be taken on an empty stomach one (1) hour before or 2 hours after eating. If stomach problems occur, take the medicine with meals. It is important to take this medicine the same way every day. Taking the medicine at the same time each day and at the same time in relation to meals will help keep a constant amount of tacrolimus in your body.
• Swallow capsules whole. Do not cut, crush, or chew capsules.
• Tacrolimus capsules should be stored at room temperature. The oral liquid should be stored at room temperature and shaken well before each use. After the date on the prescription bottle expires, discard any remaining liquid.
• Keep this and all medicines out of the reach of children and pets.
• If you miss a dose and the next dose is not due for at least 4 hours, take the missed dose right away. If the next dose is due in less than 4 hours, do not take the missed dose. Take the next dose at the scheduled time. Never take a double dose unless your doctor or pharmacist tells you to do so.
• For liquid tacrolimus, you will get a special dropper to measure the medicine. To improve its taste, you can mix the liquid medicine with orange juice or apple juice (at room temperature) in a glass container and stir well. Take the medicine right away. Then add a little juice to the glass, swish it around, and drink that. Never take tacrolimus with grapefruit juice.
• If you vomit within 20 minutes after a dose, repeat the full dose again.
• Be sure to drink a lot of liquids while you are taking tacrolimus. This lessens the chance of kidney damage.
• Do not take antacids, such as Tums® or Mylanta®, 2 hours before or after taking tacrolimus.
• The staff will take blood samples regularly to check potassium and magnesium levels in the blood and to monitor kidney and liver function.
• Plan ahead so you do not run out of your medicine. You may contact the St. JudePharmacy if your prescription has refills.
• Tacrolimus can make your skin more sensitive to sunlight. This can cause you to have severe sunburns, skin rashes, redness, and itching. Avoid exposing your skin to sunlight and tanning bulbs. Wear protective clothing, wide-brimmed hats, and sunglasses. Use lip sunblock and sunscreen (SPF15 or higher) on exposed skin.
• Some medicines may either change the blood level of tacrolimus or increase the side effects of the drug. These medicines include: azithromycin, erythromycin, fluconazole, itraconazole, metoclopramide, omeprazole, phenytoin, phenobarbital, posaconazole, potassium-sparing diuretics, rifampin, and voriconazole. Always give a complete list of medicines you are taking to your doctor or pharmacist. Check with your doctor or pharmacist before starting any new vitamins, herbals, or other medicines.
• If you receive tacrolimus by IV, the staff will give it during a 24-hour infusion in the hospital. A nurse will observe you and take your vital signs during the infusion.

Tacrolimus blood levels

The staff will tell you when they will be taking blood samples to measure tacrolimus levels in your body. On that day, do not take the medicine until after the blood sample is taken. If you have already taken tacrolimus before the blood sample is taken, please tell your doctor or pharmacist. The staff will need to reschedule your tacrolimus blood level test.