Transplant Unit

Why is this drug prescribed?

Tacrolimus is a potent immunosuppressive drug. It suppresses the blood cells which trigger a rejection response to the transplanted organ. It is important to continue taking tacrolimus regularly to help prevent rejection of your transplanted organ.

How to take tacrolimus

The dose has been worked out especially for you . The amount taken varies between patients and depends upon the levels in your blood, how well your kidneys are working , your blood pressure and your weight. Your dose is likely to change, your doctor will inform you of any dose changes.

Remember not to take your tacrolimus on the morning of your clinic visit before your blood tests. Bring the dose with you to take after your blood test.

To take the capsules remove them from the protective wrapper and the blister pack. Swallow the capsule whole with some water, do not swallow the sachet of silica gel which is in the wrapper with the capsule.

Tacrolimus is to be taken twice a day, at approximately the same times each day allowing an equal space of time (12 hours) between each dose. It is important to take tacrolimus on an empty stomach or at least one hour before or two hours after a meal.

What to do if you forget a dose or take too much

If you forget a dose take it as soon as you remember. If it is almost time for your next dose, miss out the forgotten dose and continue as normal. If you do miss a dose let the transplant team know. If you accidentally take a larger dose than recommended tell your doctor immediately.

How to store tacrolimus

Store the capsules in their protective wrapper at room temperature in a dry place. The capsules should be used within 12 months of opening the aluminium wrapper.

Keep the capsules in the blister pack until just before you take them. For example, do not take them out of the blister package to put them into a ‘dossette’ or pill box.

Possible side effects of tacrolimus

Tacrolimus is a very good drug, but it does have a rather alarming list of possible side-effects. Most patients do not get most of these, but the following have been reported by some patients at some time:

• Trembling hands and feet and muscle cramps. These usually subside with time. Drinking orange juice or tonic water may help to alleviate any cramp pain.
• Tingling and numbness in the hands and feet. This usually subsides with time.
• Tacrolimus may cause visual or nervous disturbances. If you are affected you should not drive or operate any machinery.
• Tacrolimus may affect your kidney or liver function. These will be regularly monitored at the clinic.
• Nausea (feeling sick).
• Sleeping difficulties.
• Headache
• Changes in growth of hair (both hair thinning and increased hair growth have occurred) Avoid perms or hair dyes applied for the first few months as these may weaken your hair.
• High blood pressure. You may be prescribed antihypertensive medication for your blood pressure. Also reduce salt in your diet.
• High blood glucose levels and diabetes. Your doctor will be monitoring your blood glucose levels.
• Increased risk of developing infections may occur with all anti-rejection drugs. Report any signs of infection (e.g. sore throat) to your doctor.
• Increased risk of developing skin lesions may occur with all anti-rejection drugs. Use a sunscreen protection factor 15 or higher. Report any skin lesions or lumps to your doctor.

Taking other medicines with tacrolimus

Many other drugs may interact with Tacrolimus so always check with your doctor or pharmacist before taking any new medication. This includes remedies which you can buy over the counter. Drugs to avoid buying are:

• Aspirin and aspirin containing products for pain relief. (However low doses of Aspirin for the blood are safe to take)
• Ibuprofen (also known as Brufen) and ibuprofen containing products.
• Ergotamine (used in some anti-migraine preparations eg Migril, Lingraine, Cafergot)
• Cimetidine (also known as Tagamet, used to treat indigestion and heartburn)

Grapefruit

It is best to avoid eating grapefruit or drinking grapefruit juice (it interferes with the level of tacrolimus in your blood).

Tacrolimus is also known as Prograf or FK506