Description and Brand Names

Drug information provided by: IBM Micromedex

US Brand Name

  1. Prograf

Descriptions


Tacrolimus injection is used together with other medicines to prevent the body from rejecting a transplanted organ (eg, kidney, liver, or heart). This medicine may be used with steroids, azathioprine, or mycophenolate mofetil. Tacrolimus belongs to a group of medicines known as immunosuppressive agents.

When a patient receives an organ transplant, the body's white blood cells will try to get rid of (reject) the transplanted organ. Tacrolimus works by suppressing the immune system to prevent the white blood cells from trying to get rid of the transplanted organ.

Tacrolimus is a very strong medicine. It can cause side effects that can be very serious, such as kidney problems. It may also decrease the body's ability to fight infections. You and your doctor should talk about the benefits of this medicine as well as the risks of using it.

This medicine is to be given only by or under the direct supervision of a doctor.

This product is available in the following dosage forms:

  • Solution

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of tacrolimus injection in children with liver, kidney, or heart transplants.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of tacrolimus injection in the elderly. However, elderly patients are more likely to have kidney, liver, or heart problems, which may require caution and an adjustment in the dose for patients receiving tacrolimus injection.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Amisulpride
  • Bepridil
  • Cisapride
  • Dronedarone
  • Mesoridazine
  • Mifepristone
  • Nelfinavir
  • Pimozide
  • Piperaquine
  • Ritonavir
  • Saquinavir
  • Sparfloxacin
  • Terfenadine
  • Thioridazine
  • Ziprasidone

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Aceclofenac
  • Acemetacin
  • Adenovirus Vaccine, Live
  • Afatinib
  • Alefacept
  • Alfuzosin
  • Amiodarone
  • Amitriptyline
  • Amlodipine
  • Amprenavir
  • Amtolmetin Guacil
  • Anagrelide
  • Apomorphine
  • Aprepitant
  • Aripiprazole
  • Aripiprazole Lauroxil
  • Armodafinil
  • Arsenic Trioxide
  • Asenapine
  • Aspirin
  • Astemizole
  • Atazanavir
  • Azithromycin
  • Bacillus of Calmette and Guerin Vaccine, Live
  • Bedaquiline
  • Boceprevir
  • Bosentan
  • Bromfenac
  • Bufexamac
  • Buprenorphine
  • Buserelin
  • Carbamazepine
  • Caspofungin
  • Celecoxib
  • Ceritinib
  • Chloroquine
  • Chlorpromazine
  • Cholera Vaccine, Live
  • Choline Salicylate
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clomipramine
  • Clonixin
  • Clozapine
  • Cobicistat
  • Colchicine
  • Conivaptan
  • Crizotinib
  • Cyclobenzaprine
  • Cyclosporine
  • Dabrafenib
  • Dalfopristin
  • Darunavir
  • Dasabuvir
  • Dasatinib
  • Degarelix
  • Delamanid
  • Delavirdine
  • Desipramine
  • Deslorelin
  • Deutetrabenazine
  • Dexamethasone
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Diltiazem
  • Dipyrone
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Domperidone
  • Donepezil
  • Doxepin
  • Droperidol
  • Droxicam
  • Ebastine
  • Echinacea
  • Efavirenz
  • Elbasvir
  • Eliglustat
  • Eluxadoline
  • Encorafenib
  • Enzalutamide
  • Eribulin
  • Erythromycin
  • Escitalopram
  • Eslicarbazepine Acetate
  • Esomeprazole
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Etravirine
  • Famotidine
  • Felbamate
  • Felbinac
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Fingolimod
  • Flecainide
  • Floctafenine
  • Flufenamic Acid
  • Fluoxetine
  • Flurbiprofen
  • Fluvoxamine
  • Formoterol
  • Fosamprenavir
  • Fosaprepitant
  • Foscarnet
  • Fosnetupitant
  • Fosphenytoin
  • Galantamine
  • Gatifloxacin
  • Gemifloxacin
  • Glasdegib
  • Gonadorelin
  • Goserelin
  • Granisetron
  • Grazoprevir
  • Halofantrine
  • Haloperidol
  • Histrelin
  • Hydroquinidine
  • Hydroxychloroquine
  • Hydroxyzine
  • Ibuprofen
  • Ibuprofen Lysine
  • Ibutilide
  • Idelalisib
  • Iloperidone
  • Imatinib
  • Imipramine
  • Indinavir
  • Indomethacin
  • Infliximab
  • Influenza Virus Vaccine, Live
  • Inotuzumab Ozogamicin
  • Isavuconazonium Sulfate
  • Itraconazole
  • Ivabradine
  • Ivacaftor
  • Ivosidenib
  • Ketoconazole
  • Ketoprofen
  • Ketorolac
  • Lanreotide
  • Lapatinib
  • Letermovir
  • Leuprolide
  • Levofloxacin
  • Lofexidine
  • Lomitapide
  • Lopinavir
  • Lorlatinib
  • Lornoxicam
  • Loxoprofen
  • Lumacaftor
  • Lumefantrine
  • Lumiracoxib
  • Macimorelin
  • Measles Virus Vaccine, Live
  • Meclofenamate
  • Mefenamic Acid
  • Mefloquine
  • Meloxicam
  • Methadone
  • Methotrimeprazine
  • Metoclopramide
  • Metronidazole
  • Mibefradil
  • Mitotane
  • Mizolastine
  • Modafinil
  • Moricizine
  • Morniflumate
  • Moxifloxacin
  • Mumps Virus Vaccine, Live
  • Nabumetone
  • Nafarelin
  • Nafcillin
  • Naproxen
  • Nefazodone
  • Nepafenac
  • Netupitant
  • Nevirapine
  • Nicardipine
  • Niflumic Acid
  • Nilotinib
  • Nimesulide
  • Nimesulide Beta Cyclodextrin
  • Norfloxacin
  • Octreotide
  • Ofloxacin
  • Olanzapine
  • Ombitasvir
  • Omeprazole
  • Ondansetron
  • Osimertinib
  • Oxaprozin
  • Oxcarbazepine
  • Oxyphenbutazone
  • Palbociclib
  • Paliperidone
  • Panobinostat
  • Papaverine
  • Parecoxib
  • Paritaprevir
  • Paroxetine
  • Pasireotide
  • Pazopanib
  • Pentamidine
  • Perphenazine
  • Phenobarbital
  • Phenylbutazone
  • Phenytoin
  • Piketoprofen
  • Pimavanserin
  • Pipamperone
  • Piroxicam
  • Pitolisant
  • Pixantrone
  • Poliovirus Vaccine, Live
  • Posaconazole
  • Prednisone
  • Primidone
  • Probucol
  • Procainamide
  • Prochlorperazine
  • Proglumetacin
  • Promethazine
  • Propafenone
  • Propionic Acid
  • Propyphenazone
  • Proquazone
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Quinine
  • Quinupristin
  • Ranitidine
  • Ranolazine
  • Ribociclib
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Risperidone
  • Rofecoxib
  • Rotavirus Vaccine, Live
  • Rubella Virus Vaccine, Live
  • Salicylic Acid
  • Salsalate
  • Schisandra sphenanthera
  • Sertindole
  • Sertraline
  • Sevoflurane
  • Sirolimus
  • Smallpox Vaccine
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Sodium Salicylate
  • Solifenacin
  • Sorafenib
  • Sotalol
  • St John's Wort
  • Sulindac
  • Sulpiride
  • Sultopride
  • Sunitinib
  • Tamoxifen
  • Telaprevir
  • Telavancin
  • Telithromycin
  • Tenoxicam
  • Tetrabenazine
  • Tiaprofenic Acid
  • Tizanidine
  • Tofacitinib
  • Tolfenamic Acid
  • Tolmetin
  • Tolterodine
  • Toremifene
  • Trazodone
  • Trimipramine
  • Triptorelin
  • Typhoid Vaccine
  • Valdecoxib
  • Vandetanib
  • Vardenafil
  • Varicella Virus Vaccine, Live
  • Vemurafenib
  • Venlafaxine
  • Verapamil
  • Vilanterol
  • Vinflunine
  • Voriconazole
  • Vorinostat
  • Yellow Fever Vaccine
  • Zoster Vaccine, Live
  • Zotepine
  • Zuclopenthixol

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Chloramphenicol
  • Clotrimazole
  • Danazol
  • Ertapenem
  • Lansoprazole
  • Nifedipine

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Allergy to polyoxyl 60 hydrogenated castor oil—Should not be used in patients with this condition.
  • Diabetes or
  • Hyperkalemia (high potassium in the blood) or
  • Hypertension (high blood pressure) or
  • Myocardial hypertrophy (heart is larger than normal), history of or
  • Paresthesia (numbness or tingling in the hands, arms, legs, or feet), history of or
  • Seizures (convulsions), history of or
  • Tremors—Use with caution. May make these conditions worse.
  • Infection, active (eg, bacteria, fungus, or virus)—May decrease your body's ability to fight an infection.
  • Kidney disease or
  • Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use

A nurse or other trained health professional will give you this medicine in a hospital. It is given through a needle placed into one of your veins. Your doctor may let you stay for at least the first 30 minutes after the start of the infusion and at frequent intervals thereafter.

You will only receive this medicine for a few days. Then your doctor will switch you to the oral (by mouth) form of tacrolimus.

This medicine comes with a patient information insert and patient instructions. Read and follow the instructions carefully. Ask your doctor if you have any questions.

You should not eat grapefruit or drink grapefruit juice while you are receiving this medicine. Grapefruit and grapefruit juice will increase the amount of medicine in the body.

Precautions

It is very important that your doctor check your progress while you are receiving this medicine to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Receiving this medicine while you are pregnant can harm your unborn baby. It may also cause birth defects if the father is using it when his sexual partner becomes pregnant. If you think you have become pregnant while receiving this medicine, tell your doctor right away.

You should not receive this medicine together with sirolimus (Rapamune®).

Tacrolimus injection may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Call your doctor or nurse right away if you have itching, hives, hoarseness, trouble breathing or swallowing, or any swelling of your hands, face, or mouth after you receive this medicine.

This medicine may increase your risk of getting skin cancer or cancer of the lymph system (lymphoma). Talk to your doctor if you have concerns about this risk.

This medicine may increase your risk of developing infections. Avoid being near people who are sick while you are receiving this medicine. Wash your hands often. Tell your doctor if you have any kind of infection before you start receiving this medicine. Tell your doctor if you have ever had an infection that would not go away or an infection that kept coming back.

While you are being treated with tacrolimus, and after you stop treatment with it, do not have any immunizations (vaccines) without your doctor's approval. Tacrolimus may lower your body's resistance and the vaccine may not work as well or you might get the infection the vaccine is meant to prevent. In addition, you should not be around other persons living in your household who receive live virus vaccines because there is a chance they could pass the virus on to you. Some examples of live vaccines include measles, mumps, influenza (nasal flu vaccine), poliovirus (oral form), rotavirus, and rubella. Do not get close to them and do not stay in the same room with them for very long. If you have questions about this, talk to your doctor.

This medicine may increase your risk for developing a rare and serious virus infection with the BK polyoma virus. This virus may affect how your kidneys work and cause a transplanted kidney to fail. Check with your doctor right away if you are having more than one of these symptoms: bloody urine, decreased frequency or amount of urine, increased thirst, loss of appetite, lower back or side pain, nausea, swelling of the face, fingers, or lower legs, trouble with breathing, unusual tiredness or weakness, vomiting, or weight gain.

This medicine may increase your risk of developing a serious and rare brain infection called progressive multifocal leukoencephalopathy (PML). Check with your doctor right away if you are having more than one of these symptoms: vision changes, loss of coordination, clumsiness, confusion, memory loss, difficulty speaking or understanding what others say, and weakness in the legs.

This medicine may cause serious nervous system problems. Tell your doctor right away if you have the following symptoms while using this medicine: blurred vision, dizziness, headache, mental changes, seizures, high blood pressure, or a fast heartbeat.

Hyperkalemia (high potassium in the blood) may occur while you are receiving this medicine. Check with your doctor right away if you have the following symptoms: abdominal or stomach pain, confusion, difficulty with breathing, irregular heartbeat, nausea or vomiting, nervousness, numbness or tingling in the hands, feet, or lips, or weakness or heaviness of the legs.

Tacrolimus may cause a condition called pure red cell aplasia (PRCA). This is a very rare condition where the body no longer makes red blood cells and the patient has severe anemia. Check with your doctor right away if you have a fever and sore throat, pale skin, unusual bleeding or bruising, or unusual tiredness or weakness.

Use sunscreen or sunblock lotion with a sun protection factor (SPF) of at least 15 on a regular basis when you are outdoors. Wear protective clothing and hats, and stay out of direct sunlight between the hours of 10 am and 3 pm. Avoid sunlamps and tanning beds.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

  1. Abnormal dreams
  2. agitation
  3. anxiety
  4. chills
  5. confusion
  6. cough
  7. diarrhea
  8. dizziness
  9. fever
  10. frequent urination
  11. general feeling of discomfort or illness
  12. headache
  13. itching, skin rash
  14. joint pain
  15. loss of appetite
  16. loss of energy or weakness
  17. mental depression
  18. muscle aches and pains
  19. muscle trembling or twitching
  20. nausea
  21. nervousness
  22. pale skin
  23. runny nose
  24. seeing or hearing things that are not there
  25. seizures
  26. shivering
  27. sore throat
  28. stomach pain
  29. swelling of the feet or lower legs
  30. tingling
  31. trembling and shaking of the hands
  32. trouble with sleeping
  33. unusual bleeding or bruising
  34. unusual tiredness or weakness
  35. vomiting

Less common

  1. Blurred vision
  2. chest pain
  3. increased sensitivity to pain
  4. muscle cramps
  5. numbness or pain in the legs
  6. ringing in the ears
  7. sweating

Rare

  1. Enlarged heart
  2. flushing of the face or neck
  3. weight loss

Incidence not known

  1. Black, tarry stools
  2. blistering, peeling, or loosening of the skin
  3. bloating
  4. bloody urine
  5. blurred vision
  6. constipation
  7. drowsiness
  8. fainting
  9. fast, slow, or irregular heartbeat
  10. heartburn
  11. increased blood pressure
  12. increased thirst
  13. indigestion
  14. joint pain
  15. lightheadedness
  16. lower back or side pain
  17. pinpoint red spots on the skin
  18. pounding or rapid pulse
  19. red, irritated eyes
  20. red skin lesions, often with a purple center
  21. skin sores
  22. stomach pain
  23. troubled breathing
  24. ulcers or white spots in mouth or on lips
  25. weakness
  26. weight gain
  27. yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  1. Belching
  2. difficulty with moving
  3. muscle stiffness

Less common

  1. Body aches or pain
  2. burning or stinging of the skin
  3. cracks in the skin
  4. crying
  5. delusions of persecution, mistrust, suspiciousness, or combativeness
  6. dysphoria
  7. excessive muscle tone
  8. false beliefs that cannot be changed by facts
  9. false or unusual sense of well-being
  10. feeling of constant movement of self or surroundings
  11. feeling of unreality
  12. feeling that others are watching you or controlling your behavior
  13. feeling that others can hear your thoughts
  14. increased sensitivity of the skin to sunlight
  15. large, flat, blue or purplish patches in the skin
  16. muscle tension or tightness
  17. painful blisters on the trunk of the body
  18. painful cold sores or blisters on the lips, nose, eyes, or genitals
  19. poor insight and judgment
  20. problems with memory or speech
  21. quick to react or overreact emotionally
  22. rapidly changing moods
  23. redness or other discoloration of the skin
  24. restlessness
  25. scaly skin
  26. sensation of spinning
  27. sense of detachment from self or body
  28. severe mood or mental changes
  29. severe sunburn
  30. sleepiness or unusual drowsiness
  31. sore mouth or tongue
  32. sores on the skin
  33. swelling or inflammation of the mouth
  34. tender, swollen glands in the neck
  35. trouble recognizing objects
  36. trouble thinking and planning
  37. trouble walking
  38. unusual behavior
  39. white patches in the mouth, tongue, or throat

Incidence not known

  1. Change in color vision
  2. decreased weight
  3. difficulty seeing at night
  4. feeling hot and cold
  5. hearing loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.