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Generic Name

tacrolimus (tack row LEEM us)


Trade Name

Prograf (1 mg, 5 mg)
This drug is not available in a generic form.


What is tacrolimus?

Tacrolimus depresses the immune system. This is necessary when an organ transplant is done so that the organ is not rejected by the normal immune function of the body.


What is it used for?

Tacrolimus is used after organ transplantation. In addition, it is being tested in a variety of autoimmune diseases, including those in gastroenterology such as Crohn’s disease or ulcerative colitis, where an over-reactive immune system may be a problem.


How do I take it?

Follow your physician’s instructions carefully. Take the medication on an empty stomach for best blood absorption. Store the drug in a tightly sealed container. Keep all medications away from children. Never share your medications with anyone else.


What do I do for a missed dose?

If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and return to your regular schedule. Do not double up on this medication.


Are there interactions with food or beverages?

Food of any type will reduce the blood absorption of tacrolimus. As noted above, take the medication on an empty stomach at least 1 hour before eating so full absorption occurs.


Are there interactions with other drugs?

An interaction generally means that one drug may increase or decrease the effect of another drug. Also, the more medications a person takes, the more likely there will be a drug interaction.

Interactions with this drug may occur with the following:

  • cisplatin (Platinol)
  • cyclosporine (Sandimmune, Neoral)
  • antifungal drugs (Nizoral, Sporanox)
  • antibiotics (erythromycin, Biaxin)
  • calcium blockers (Procardia, Calan)
  • anti-convulsants (Dilantin, Tegretol, phenobarbital)
  • diuretics (Aldactone, Dyazide)
  • metoclopramide (Reglan)
  • cimetidine (Tagamet)
  • anti-tuberculosis drugs (rifampin)


Is there a problem if I have another disorder or disease?

At times, a drug may have a different or enhanced effect when other diseases are present. At other times, the drug may worsen or effect another disease.

With this drug, the following disorders may be a problem:

  • hypertension (high blood pressure)
  • chronic kidney disease
  • low white cell or platelet count
  • bone marrow problems
  • previous lymph gland tumor called lymphoma
  • diabetes mellitus


What about allergies?

People who have known allergies or asthma may be at an increased risk for a reaction from any new medication. The physician should always know a patient’s allergy history. Signs of an allergic reaction are skin rash, hives or itching. Of course, a person should not take tacrolimus if there has been a previous reaction to this or castor oil in injectable form.


What if I’m pregnant, considering pregnancy or breast-feeding?

Most females now know that, if possible, no drug, including alcohol, should be taken during pregnancy or lactation. The potential danger, of course, is an injury to the baby. However, some drugs are much safer than others in this regard. So, the FDA has a grading system for each drug which reflects what is known medically. It ranks drugs from A, where medical studies show no evidence for danger to the fetus or mother, to B, C, D and X, where the medical evidence indicates that the risk to the fetus outweighs any benefit to the mother. Tacrolimus is ranked C. Always consult your physician before taking any drug during or when planning pregnancy.


What are the effects on sexual function?

There are no known adverse effects on sexual function. However, tacrolimus is associated with birth defects and abortions in animal studies. Discuss this with the physician. Effective contraception should be used in fertile women.


Are there other precautions?

  • Tacrolimus may elevate the blood sugar producing a diabetic condition in up to 50% of liver transplant patients.
  • There is an increased risk of developing a tumor called lymphoma, so have regular blood tests as directed.
  • Inform your physician promptly at the first sign of infection such as fever, chills, sore throat or abnormal bruising or bleeding, or if you or your family have a history of diabetes mellitus.


How long is it safe to take tacrolimus?

After several weeks of regular use, it can be determined if this drug is effective. Long-term use is required but constant monitoring of blood levels and physician evaluation is necessary.


How about side effects?

Adverse reactions can occur with any drug, even over-the-counter medications. Some of these are mild such as a stomach upset, which may be avoided by taking the medication with food. Minor reactions may go away on their own but if they persist, contact the physician. For major reactions, the patient should contact the physician immediately.

For tacrolimus, the following are the observed side effects:


  • tremor
  • headache
  • diarrhea
  • constipation
  • nausea
  • vomiting
  • insomnia
  • numbness
  • rash
  • weakness
  • edema
  • increase in blood pressure
  • increase in blood glucose levels


  • convulsions
  • seizures
  • hallucinations
  • confusion
  • severe sore throat


A physician’s comment…

Tacrolimus has opened up the entire field of organ transplantation since it appears to be a much easier drug to take than the other major transplant drug, cyclosporine. There is always a need to follow up carefully with frequent blood pressure and blood studies. Its role in the treatment of other illnesses is still a bit experimental. However, good effects may result in selective cases.