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Tacrolimus

Immunosuppressant

Brand names:

Prograf®

Other names:

FK506

Often used for:

Graft-versus-host disease (GVHD) after stem cell transplant, prevent rejection after organ transplant

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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 response and prevent or treat GVHD after stem cell transplant. Tacrolimus may also be given after an organ transplant to prevent the immune system from attacking or rejecting the transplanted organ. 

Your child may have a pharmacogenomic test to find out how their genes affect the way that they will use or respond to certain medicines. This can help your care team know the best dose of medicine for your child. Your doctor or pharmacist will let you know if your child needs a higher dose based on their genetic testing.

Your child will have regular blood draws to check potassium and magnesium levels in the blood and to monitor kidney and liver function.

Your care team will also measure tacrolimus levels in the blood. The dose may change based on these tests. Your care team will let you know when tests will be performed to measure tacrolimus levels in the blood. On the day of the test, your child should not take the medicine until after the blood sample is collected. If you have already taken tacrolimus before the lab is drawn, please tell your doctor or pharmacist.

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May be given as a capsule by mouth

 
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May be given 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

  • Increased risk of infection
  • Tremors (shaking of the body)
  • High blood pressure
  • Low blood magnesium levels
  • High blood potassium levels
  • Decreased kidney function
  • Nausea and vomiting
  • Stomach pain
  • Diarrhea
  • Constipation
  • Headache
  • Joint pain
  • Trouble sleeping
  • Vision changes
  • Numbness or tingling in hands and feet   
  • Seizures (rare)
  • Fatigue or weakness
  • Low red blood cell count (anemia)
  • High blood sugar levels (diabetes)
  • Decreased liver function

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. Find more information on side effects.

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Possible long-term or late effects

Patients who take immunosuppressants like tacrolimus may be at risk for medical problems later in life. These can include second cancers (such as lymphoma or skin cancer) or fertility problems. Your care team can give you more information about your child’s risk.

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Tips for patients and families

Be sure to discuss all questions and instructions with your doctor or pharmacist.

  • 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.
  • While taking this medicine, your child should not eat grapefruit or drink juice or beverages containing grapefruit.
  • This medicine may make skin more sensitive to sunlight and increase risk for sunburn. Take steps to protect skin from the sun. Have your child wear sunscreen and protective clothing. Avoid sun exposure when possible.
  • This medicine can weaken the immune system and increase the risk of infection. Wash hands often, keep patient areas clean, and avoid contact with people who are sick.
  • Tacrolimus can affect your child’s ability to get pregnant or father a child. Talk to your doctor about the risk of fertility problems and options for protecting fertility.
  • It is important that patients tell the care team if they are sexually active, pregnant, or breastfeeding.
  • Sexually active patients should take steps to prevent pregnancy during treatment and for 6 months after treatment is complete.

Tacrolimus at home:

  • When taken by mouth, this medicine comes in different forms. 
  • Give the medicine at the same time each day and in the same way in relation to meals. Always give with food or always give on an empty stomach. This will help keep a constant amount of tacrolimus in the body. Take with or without food. Take with food if stomach upset occurs.  
  • Capsules: 
    • Swallow capsules whole. Do not crush, chew, or break before swallowing. 
  • Bottled medicine (oral liquid): 
    • Shake well. Use the measuring device that comes with the medicine.
    • To improve the taste, 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.
  • Your child should not take antacids, such as Tums® or Mylanta®, 2 hours before or after taking this medicine.
  • If vomiting occurs within 30 minutes of taking tacrolimus by mouth, give another dose of medicine.
  • Give a missed dose as soon as possible. If it is near the time of the next dose, skip the dose as instructed by your health care provider. Do not give 2 doses at the same time.  
  • Store at room temperature.
  • Do not use the medicine past the expiration date.

This medicine can pose a health risk to caregivers or others who come in contact with the medicine. Follow instructions for safe handling, storage, and disposal. Keep all medicines out of the reach of children and pets.

Learn more about tacrolimus

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Always check the medication label. Many medicines look the same. Do not take any new medicine, including over-the counter medicines or supplements, without checking with your doctor or pharmacist. Talk to your doctor or pharmacist about what to do in the case of a missed dose, allergic reaction, or medical emergency. 

This information is not intended to be a complete guide and is not a substitute for talking with your provider. Medicine names, appearance, formulas, or availability may vary by clinic location. Always follow the instructions given by your care team.