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Tacrolimus is an immunosuppressant drug used to prevent the body from rejecting a transplanted organ. tacrolimus is typically used to reduce the body’s natural immunity in patients who receive kidney, liver, pancreas, lung and heart transplants.


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  • If you can, avoid contact with people with colds or other infections.
  • Keep cuts and scratches clean. Use good personal hygiene, especially for your mouth, teeth, skin, hair and hands.
  • Tacrolimus may increase your risk of getting certain types of cancer. Talk to your doctor about this risk.
  • Do not eat raw oysters or other shellfish while you are taking tacrolimus and take special care to ensure that oysters and shellfish are fully cooked. Even eating oysters from “clean” water or good restaurants does not guarantee that the oysters do not contain the bacteria.
  • Avoid persons who have recently taken oral poliovirus vaccine. Do not get close to them, and do not stay in the same room with them for very long. If you cannot take these precautions, you should consider wearing a protective facemask that covers the nose and mouth.
  • Tacrolimus is not available in all countries. If you are traveling to another country, be sure you will have a supply of your medicine.
  • Grapefruits and grapefruit juice may increase the effects of tacrolimus by increasing the amount of this medicine in the body. You should not eat grapefruit or drink grapefruit juice while you are taking this medicine.

How tacrolimus works

Tacrolimus’ mechanisms of action are not unlike those of cyclosporine. Like cyclosporine, tacrolimus inhibits cytokine production, including IL-2, inhibits expression of IL-2 receptors, and blocks cell division.

Taking tacrolimus

  • Take tacrolimus exactly as directed by your doctor. If you do not understand these directions, ask your doctor, nurse or pharmacist to explain them to you.
  • Keep out of the reach of children.
  • Store away from heat and direct light.
  • Do not store in the bathroom, near the kitchen sink, or in other damp places.
  • Throw away any medication that is outdated or no longer needed, and talk to your pharmacist about the proper disposal of your medication.


If you miss a dose. When you start to take tacrolimus, ask your doctor what you should do if you forget a dose, and write down these directions so that you can refer to them later. If you miss more than one dose, it is important that you call your doctor.

Over Dosage. In case of overdose, call your local poison control center. If the victim has collapsed or is not breathing, call local emergency services at 911.

Common side effects

Although side effects from tacrolimus are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:

  • diarrhea
  • insomnia
  • loss of appetite
  • stomach pain
  • upset stomach
  • vomiting

Dangerous side effects

If you experience any of the following symptoms, call your doctor immediately:

  • difficulty breathing and/or wheezing
  • itching
  • painful, frequent or decreased urination
  • seizures
  • severe or continued headaches
  • skin rash and/or hives
  • sore throat, fever and/or chills
  • swelling of the feet, ankles, lower
  • legs, and hands
  • tremor
  • unusual bleeding or bruising
  • weakness
  • weight gain
  • yellowing of the skin or eyes

Tacrolimus and pregnancy

Some women have become pregnant and had babies while receiving tacrolimus after organ transplantation. Some of the newborn babies had temporary kidney problems after birth. Some babies were born prematurely.

Tacrolimus also passes into breast milk and may cause the same side effects in the baby that it does in the people taking it. Therefore, it may be necessary for you to stop breast-feeding during treatment.

Drug interactions

Before taking tacrolimus, tell your doctor if you are taking, have taken, or need to take any of the following medicines:

Antacids; Amiloride (e.g. Midamor, Moduretic); Bromocriptine (e.g. Parlodel); Carbamazepine (e.g. Tegretol); Cimetidine (e.g. Tagamet); Cisapride (e.g. Propulsid); Clarithromycin (e.g. Biaxin); Clotrimazole (e.g. Mycelex, Lotrimin); Cyclosporine (e.g. Neoral, Sandimmune); Danazol (e.g. Danocrine); Diltiazem (e.g. Cardizem); Erythromycin (e.g. E-Mycin); Fluconazole (e.g. Diflucan); Ganciclovir (e.g. Cytovene); HIV protease inhibitors such as indinavir (e.g. Crixivan); Itraconazole (e.g. Sporanox); Ketoconazole (e.g. Nizoral); Methylprednisolone (e.g. Medrol); Metoclopramide (e.g. Reglan); Nefazodone (e.g. Serzone); Nicardipine (e.g. Cardene); Nifedipine (e.g. Adalat, Procardia); Omeprazole (e.g. Prilosec); Oral contraceptives (birth control pills); Phenobarbital; Phenytoin (e.g. Dilantin); Rifabutin (e.g. Mycobutin); Rifampin (e.g. Rifadin, Rimactane); Ritonavir (e.g. Norvir); Spironolactone (e.g. Aldactone); St. John’s Wort and products containing St. John’s Wort; Triamterene-containing drugs (e.g. Dyazide, Dyrenium, Maxzide); Troleandomycin (e.g. Tao); Verapamil (e.g. Calan, Isoptin); vitamins

Brand names

Prograf, manufactured by Astellas Pharma US, Inc.

ASTAGRAF XL, manufactured by Astellas Pharma US, Inc.

Reference and Publication Information

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