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Supportive Care

Brand names:


Other names:


Often used for:

Graft vs. host disease (GVHD) after stem cell transplantation, Severe aplastic anemia

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About tacrolimus

Tacrolimus is a medicine that suppresses the immune system (immunosuppressant). It is used to decrease the body’s natural immune system and prevent or treat GVHD in hematopoietic cell transplant.

Tacrolimus is broken down by certain enzymes in the body. A genetic test may be performed to see how well a patient’s enzymes function. Patients who break down tacrolimus faster than normal may receive a higher dose of the medicine.

Patients will have regular blood draws to check the amount of tacrolimus, potassium, and magnesium levels in the blood and to monitor kidney and liver function. Tacrolimus doses may change based on levels in the blood.

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May be taken as a capsule by mouth

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May be taken as a liquid by mouth

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May be given as a liquid into a vein by IV

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May be applied on the skin

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Possible side effects

  • Kidney problems
  • High blood pressure
  • Tremors (shaking of the body)
  • Numbness or tingling in hands and feet
  • Low blood magnesium levels
  • High blood potassium levels
  • Increased risk of infection
  • Nausea and vomiting
  • Stomach pain
  • Liver problems
  • Headache
  • Trouble sleeping
  • Vision changes
  • Seizures
  • Low red blood cell count (anemia)
  • High blood sugar levels (diabetes)

Not all patients who take tacrolimus will experience these side effects. Common side effects are in bold, but there may be others. Please report all suspected side effects to your doctor or pharmacist.

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Possible late effects

Some patients may experience long-term or late effects of treatment that may continue or develop months or years after treatment ends. Possible late effects due to tacrolimus include:

  • Secondary cancers (such as lymphoma or skin cancer)
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Tips for families

Be sure to discuss these and other recommendations with your doctor or pharmacist.

  • The staff will let patients know when tests will be performed to measure tacrolimus levels in the blood. On that day, patients should not take the medicine until after the blood sample is obtained.
  • Patients should not take antacids (such as ranitidine) within 2 hours before or after taking tacrolimus, unless recommended by a doctor.
  • While taking this medicine, patients should not eat grapefruit or Seville (bitter) oranges. Patients also should not drink juice or beverages containing grapefruit or Seville orange.
  • This medicine may make skin more sensitive to sunlight and increase risk for sunburn. Patients should take steps to protect skin from the sun. Wear sunscreen and protective clothing. Avoid sun exposure when possible.
  • Sexually active patients should take steps to prevent pregnancy during treatment and for 6 months after completion of therapy.
  • Patients should tell their doctor if they are pregnant or breastfeeding.

Tacrolimus at home:

  • Tacrolimus can be taken with or without food. Take with food if stomach upset occurs.
  • 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 the body.
  • Swallow capsules whole. Do not cut, crush, or chew capsules.
  • Store tacrolimus at room temperature.
  • If vomiting occurs within 30 minutes of taking tacrolimus by mouth, another dose should be given.
  • Shake liquid tacrolimus well before use. To improve the taste of liquid tacrolimus, mix 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. Never take tacrolimus with grapefruit juice.
  • Give a missed dose as soon as possible. If it is near the time of the next dose (within 4 hours), skip the dose. Do not give 2 doses at the same time.
  • Do not use the medicine past the expiration date.
  • Follow instructions for safe handling, storage, and disposal.