Pharmacy - Tacrolimus

Why have I been prescribed tacrolimus?

Tacrolimus is a medicine that can be used to manage auto immune conditions. It is used in several specialities including renal, dermatology, rheumatology & neurology. It is also used as an anti-rejection medicine after organ transplantation to stop the body rejecting the transplant. The clinician that recommends this medicine for you will tell you about your condition and why tacrolimus is being prescribed.

How does it work?

Tacrolimus belongs to a group of medicines known as immunosuppressants. It helps to reduce or suppress your body’s own immune system to limit or prevent tissue damage rather than having an immediate effect on symptoms. Your immune system helps to protect you against infections. However, sometimes it can overreact or react abnormally and cause illness. Tacrolimus can be used to treat these conditions, often in combination with other medicines.

Tacrolimus works slowly and may take up to 12 weeks to take effect.

Unless you have severe side effects it is important to continue taking it even if you do not notice any change in your symptoms.

What dose do I take?

The dose of tacrolimus depends on your weight and the medical condition being treated. Your dose will also depend on blood tests.

How do I take it?

Tacrolimus is available in different brands. It is important that you stay on the same brand. Depending on the brand, tacrolimus is either taken once a day or twice a day (12 hours apart) with a full glass of water. The dose should be taken on an empty stomach, preferably at least 1 hour before or 2-3 hours after having food. The instructions on how to take your tacrolimus will be on a printed label on the box. You should take the medicines as directed by your doctor.

Twice Daily Preparations    
Adoport    
Prograf    
Modigraf   

Once Daily Preparations
Advagraf
Envarsus
Dailiport

If you have been prescribed a once a day preparation they need to be swallowed whole. Do not break or chew the tablets and do not open the capsule.

Does tacrolimus interfere with my other medicines?

Tacrolimus can interact with other medicines. You should tell your doctor which medicines you are taking before starting tacrolimus.

Other medicines which can cause problems with tacrolimus include:

• Some antifungal and antibiotic medications, e.g. fluconazole and clarithromycin
• Anti-epileptic medication, e.g. phenytoin and carbamazepine
• Some blood pressure medications, e.g. diltiazem and verapamil
• You should only take non-steroidal anti-inflammatory drug (NSAIDs) on the advice of your GP or clinician
• St John’s wort and some other herbal preparations should be avoided
• Avoid drinking grapefruit juice
• You should avoid ‘live’ vaccines but most travel vaccines and the ‘flu jab & COVID vaccines are ok

Always check with your doctor or pharmacist first before starting any new medication.

It is safe to drink alcohol in moderation while taking tacrolimus but you are recommended to have alcohol free days without saving units up to drink all in one go.

Can tacrolimus cause side effects?

All medicines can cause unwanted side effects. Side effects that can occur with tacrolimus include:

• You are more likely to catch infections so avoid close contact with people with severe active infections. If you catch an infection (temperature >39 degrees, unresolving cough/cold, flu or COVID symptoms), contact your health professional for advice
• Stomach upsets, such as feeling sick or diarrhoea. Headache, tremor or high blood pressure
• High blood sugar levels or unmask diabetes
• Feeling dizzy, blurred vision
• Tacrolimus can affect your kidneys and liver, so you will need to have regular blood tests to monitor the levels
• Hair loss, rash

In the long-term there is a higher risk of tumours including skin cancers and a condition called lymphoproliferative disorders compared to the general population. We recommend that you use a high factor sun cream (SPF 30 or more) to prevent skin damage and regular surveillance, such as cervical screening (smear tests) for women.

What happens if I forget to take a dose?

On twice daily tacrolimus:
If you remember within 6 hours of your dose being due then take your dose as usual. If it is more than 6 hours since your dose was due, do not take the dose and take your next dose at the normal time.

On once daily tacrolimus:
If you remember within 12 hours of your dose being due then take your dose as usual. If it is more than 12 hours since your dose was due, do not take the dose and take your next dose at the normal time.

Is it ok to have tacrolimus during pregnancy and breastfeeding?

If you are planning to become pregnant while you are taking tacrolimus, you should discuss this with your clinical team.
Tacrolimus is thought to be safe whilst pregnant or breastfeeding but blood tests will need to be checked more regularly.

Do I need any special checks while on tacrolimus?

Tacrolimus can affect your immune system and other blood cells. Although these effects are rare, it is important that you have regular blood tests to check for early signs of changes in the blood.

Tips to reduce your risk of infection

• Try to avoid close contact with people you know have an infection
• Wash your hands regularly and carry round a small bottle of antibacterial gel to use
• Keep your mouth clean by brushing your teeth regularly
• Make sure your food is stored and prepared properly
• Try to keep your house clean and hygienic, especially the kitchen, bathrooms and toilets
• Have your yearly ‘flu vaccine and COVID boosters

Can I travel while taking tacrolimus?

If you are planning on travelling whilst tacrolimus, it is important to discuss this with the specialist clinic. Keep in mind the following advice:

• Always take extra supplies of your medication when travelling
• Keep your medication in your hand luggage
• Carry your medication in their original boxes
• If you’re travelling to a different time zone, try to take your medication at your usual 'native' time. If this is difficult, discuss with your clinician in the clinic.

In many parts of the world there is a greater risk of developing an infection. To help avoid picking up these infections you must:

• Wash your hands thoroughly, especially after using public toilets
• Use alcohol hand gel: you can buy this from most supermarkets and chemists to take with you
• Follow the advice below on food and water safety:

–    Don’t drink tap water or use it to brush your teeth. Use bottled water instead
–    Don’t put ice in drinks
–    Bottled fizzy drinks with an unbroken seal are usually safe
–    Boiled water and drinks made with boiled water are usually safe
–    Don’t eat salads, raw (uncooked) fruits and vegetables, unless you have washed and peeled them yourself
–    Don’t eat food that has been kept at room temperature in warm places or that could have been exposed to flies
–    Don’t eat or drink unpasteurised milk, cheese, ice cream or other dairy products
–    Don’t eat raw or undercooked seafood

Can I have vaccinations while taking tacrolimus?

Whilst taking tacrolimus, you must not have any live vaccines. Your immune system is dampened down whilst taking tacrolimus, which increases your risk of infection. Other types of vaccines are safe for you to have. Ensure you discuss any vaccinations you need with the clinic.

We strongly advise that all patients who have a reduced immune system have the flu vaccination each year and follow the recommended COVID vaccination schedule – your clinical team will advise you. If your GP or Practice Nurse needs advice about vaccinations, they can contact the clinic.

Contact details

Medicines information: 0161 206 5223