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Tacrolimus

Drug Class: Commonly Known As: Category:
Immune Suppressant Prograf® Adult, Children

Tacrolimus - What is it for

Tacrolimus is an immunosuppressant used to prevent organ rejection of solid organ transplants and for treatment of a variety of auto-immune diseases e.g for nephrotic syndrome. It can also be used to prevent graft-versus-host disease after haematopoietic stem cell transplant. It can be intended for long term use.

Tacrolimus works by suppressing the immune system to prevent organ rejection and graft-versus-host disease.

Tacrolimus - Side Effects, Precautions, and Contraindications

What side effects can Tacrolimus cause?

Tacrolimus weakens your body’s defence mechanism (immune system) to fight against infection. Therefore, you may be more prone to infections while you are taking tacrolimus. Seek medical attention promptly you have a fever (temperature above 38°C) or feel unwell eg. with flu-like symptoms, sweat and chills.

Some other possible side effects of Tacrolimus include:

  • Stomach discomfort, nausea and vomiting, diarrhea, constipation
  • Increased blood pressure
  • Increased blood sugar, diabetes mellitus
  • Increased potassium in blood
  • Headache, tremor, insomnia

There are some potentially serious but rare side effects that may be experienced when you are using Tacrolimus. These include:

  • Newly appeared moles and discolouration of skin (Avoid prolonged sun exposure, wear protective clothing and use sunscreen)
  • Severe kidney problems manifesting as swelling of hands and feet or inability to pass urine
  • Severe headache, seizures, visual disturbances.
  • Heart problems manifesting as chest pain, shortness of breath, feeling faint and light-headed.

Stop using Tacrolimus and inform your doctor immediately if you experience any of the potentially serious side effects.

Inform the doctor if you experience any side effects, so that the necessary monitoring may be conducted. Seek immediate medical attention if side effects are serious and urgent for e.g. severe skin reactions such as skin ulcers or allergic reactions such as itchy rash, blistered, peeling skin, swelling in face/ lips/ tongue/ throat, tightness in chest or throat and/ or trouble breathing.

Before taking Tacrolimus, what precautions must I follow?

What food or medicine must I avoid when I take Tacrolimus?

Do not give your child or yourself any other medications or herbal products without consulting your doctor or pharmacist. Some medication or food may reduce its efficacy, or increase the incidence of side effects where close monitoring is required. These include:

1. Grapefruit or pomelo, St John’s wort, alcohol

2. Live vaccines such as BCG, MMR, chickenpox vaccine and some forms of polio or influenza vaccines.

3. Certain antibiotics and antifungals

4. NSAIDs eg. ibuprofen

Tacrolimus - Dosage and How to Use

How should Tacrolimus be used?

​ It is important that you take this medication exactly as prescribed by the doctor. Your doctor may change the dosage of tacrolimus depending on blood tests results. Always follow the doctor’s instructions strictly. Do not stop taking tacrolimus unless you are told to do so by your doctor. Do not take more or less than required unless instructed

Tacrolimus is usually given twice daily and should be given at the same time each day. It should be taken on an empty stomach or at least 1 hour before or 2 hours after a meal, to achieve maximal absorption. Take with food only if you experience stomach upset after taking Tacrolimus. It is advisable to be consistent with the timing and composition of meals if taken with food.

  • Tacrolimus 0.5mg Capsule/ Tacrolimus 1mg Capsule
    - Capsules should not be opened, crushed or chewed. Capsules should be swallowed whole with a glass of    water.
    - Capsules should be taken immediately following removal from the blister.
  • Tacrolimus 1mg/mL Suspension

Shake well before taking the medication. Do not administer the suspension once passed the expiry date stated on the bottle.

What should I do if I miss a dose?

​Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for the next dose. Do not double dose to make up for the missed dose.

What should I do if I overdose?

Tacrolimus - Handling

How should I handle Tacrolimus safely?

​Take precautions to avoid exposure: wear gloves and mask when handling Tacrolimus. Please refer to Patient's Information Leaflet on "Safe Handling of Oral Cytotoxic or Caution Medications" for details.

Tacrolimus - Storage

How should I store Tacrolimus?

Keep away from children;#Keep in a cool, dry place, away from direct sunlight;#

How should I dispose of Tacrolimus safely?

Tacrolimus - Additional Information

​Compliance to follow up visits

While taking Tacrolimus, you should be seeing your specialist doctor regularly to ensure that your treatment is optimized and to address any concerns relating to your treatment. Regular laboratory tests may be conducted as directed by your doctor to monitor your condition and treatment progress.

Supply of Drugs
You are advised not to purchase more Tacrolimus than required before your next visit in case of dose changes or discontinuation of therapy. Do not switch brands without consulting your doctor or pharmacist.

Caregiver advice
Do not give Tacrolimus to anyone else. It has been prescribed for a specific condition, and may not be the correct treatment for another person, and would be dangerous if the other person is pregnant or breastfeeding.

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