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Tacrolimus (By mouth)

Tacrolimus (ta-KROE-li-mus)

Prevents your body from rejecting an organ after transplant.

Brand Name(s):

Astagraf XL, Hecoria, Novaplus Tacrolimus, Prograf

There may be other brand names for this medicine.

When This Medicine Should Not Be Used:

This medicine is not right for everyone. Do not use this medicine if you had an allergic reaction to tacrolimus.

How to Use This Medicine:

Capsule, Long Acting Capsule

  • Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.
  • Immediate-release capsule: You may take this medicine with or without food, but take it the same way each time (for example, always with food).
  • Extended-release capsule: Take it every morning on an empty stomach at least 1 hour before or 2 hours after breakfast.
  • Swallow the extended-release capsule whole. Do not crush, break, or chew it.
  • Use only the brand of medicine your doctor prescribed. Other brands may not work the same way.
  • This medicine is always used together with other medicines. Make sure you understand when to take each medicine during the day.
  • This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.
  • Missed dose:
    • You must use this medicine on a fixed schedule. Call your doctor or pharmacist if you miss a dose.
    • Astagraf XL? (extended-release capsule): If you miss a dose and remember within 14 hours, take the missed dose right away. If more than 14 hours have passed since your regular dose time, skip the missed dose. Return to your regular schedule on the next day.
  • Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

  • Some medicines and foods will affect how tacrolimus works. Tell your doctor if you are using bromocriptine, cyclosporine, danazol, birth control pills, ethinyl estradiol, methylprednisolone, metoclopramide, mycophenolic acid, nefazodone, sirolimus, medicine for high blood pressure (such as benazepril, candesartan, diltiazem, enalapril, lisinopril, losartan, nicardipine, nifedipine, olmesartan, valsartan, verapamil), stomach medicine (such as cimetidine, lansoprazole, omeprazole), or an antacid that contains magnesium or aluminum.
  • Tell your doctor if you are using St John's wort, amiodarone, cisplatin, ganciclovir, medicine to treat seizures (such as carbamazepine, phenobarbital, phenytoin), or a diuretic (water pill, such as spironolactone, triamterene).
  • Tell your doctor about any medicine you take to treat an infection. This includes medicine to treat bacterial infections (such as amikacin, chloramphenicol, clarithromycin, erythromycin, gentamicin, rifabutin, rifampin, streptomycin, troleandomycin), hepatitis C infection (such as boceprevir, telaprevir), HIV/AIDS (such as atazanavir, darunavir, indinavir, lopinavir, nelfinavir, ritonavir, tenofovir), or fungus infections (such as amphotericin B, caspofungin, clotrimazole, fluconazole, itraconazole, ketoconazole, posaconazole, voriconazole).
  • Do not eat grapefruit or drink grapefruit juice while you are using this medicine.
  • This medicine may interfere with vaccines. Ask your doctor before you get a flu shot or any other vaccines.
  • Do not drink alcohol while you are using this medicine.

Warnings While Using This Medicine:

  • Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, diabetes, heart disease, heart rhythm problems, high blood pressure, or any type of infection.
  • This medicine may cause the following problems:
    • Higher risk of infection (including bacteria, virus, and fungus infections)
    • Higher risk of skin cancer or cancer of the lymph system (lymphoma)
    • Diabetes
    • High blood pressure
    • Enlarged heart
    • Nervous system disorder
    • Kidney problems
    • Anemia (low red blood cell counts)
    • High potassium levels in your blood
    • Changes in heart rhythm
    • Stomach or bowel problem (such as perforation)
  • This medicine may make your skin more sensitive to sunlight. Wear sunscreen. Do not use sunlamps or tanning beds.
  • Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
  • Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

  • Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
  • Change in how much or how often you urinate, painful urination
  • Confusion, weakness, uneven heartbeat, trouble breathing, numbness in your hands, feet, or lips
  • Dizziness, lightheadedness, fainting
  • Fast, slow, uneven, or pounding heartbeat
  • Fever, chills, cough, sore throat, and body aches
  • Headache, vision changes, seizures, tingling or numbness
  • Increased thirst or hunger
  • Tremors or muscle twitching
  • Trouble breathing, rapid weight gain, swelling in your hands, ankles, or feet
  • Unusual bleeding, bruising, or weakness
  • Weakness on one side, confusion, clumsiness, trouble thinking clearly

If you notice these less serious side effects, talk with your doctor:

  • Diarrhea, constipation, nausea, vomiting
  • Joint pain or back pain
  • Trouble sleeping

If you notice other side effects that you think are caused by this medicine, tell your doctor

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

Last Updated: 4/8/2016

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