Tacrolimus, Oral/Injection

Type of medicine: immunosuppressant

Generic and brand names: tacrolimus, injection; tacrolimus, oral; Prograf; Prograf

This medicine is taken by mouth or given by IV infusion (slow drip through a needle into your vein) to keep your body from rejecting a new organ after a transplant. It may be used for other conditions as determined by your health care provider.

Before taking this medicine, tell your health care provider if you have ever had:

• an allergic reaction to any medicine or to castor oil
• cancer
• diabetes
• heart disease
• high blood pressure
• kidney disease
• liver disease
• nervous system problems
• hyperkalemia (high potassium levels in the blood).

Females of childbearing age: Tell your health care provider if you are pregnant before you start this treatment. Do not take this medicine during pregnancy because it may harm the baby. Also, do not breast-feed while taking this medicine.

At first you may receive this medicine through an IV, and later you may take it by mouth (in the form of capsules). The infusions are given by your health care provider.

Take this medicine exactly as your health care provider prescribes. It is usually taken twice a day on an empty stomach (1 hour before or 2 hours after a meal). If you do not understand how or when to take your medicine, ask your health care provider to explain.

If you miss a dose, take it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your health care provider.

You will need to have regular tests to find out how this medicine affects you. Keep all appointments for these tests.

You may get infections more easily when you are taking this medicine. Stay away from people with colds, flu, or other infections. Also, do not have any vaccines without getting your health care provider's approval first.

This medicine may cause abnormal growths, particularly on your skin. Ask your health care provider what to look for, and report any growths right away.

If you need emergency care, surgery, or dental work, tell the health care provider or dentist you are taking this medicine.

This medicine may lead to diabetes in some people. Notify your health care provider if you develop increased thirst or hunger or need to urinate more often.

Diabetics: This medicine may affect your blood sugar level and change the amount of insulin or other diabetes medicines you may need. Talk to your health care provider about this.

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your health care provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your health care provider right away. If you cannot reach your health care provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (report these to your health care provider right away): Severe headache; trembling; diarrhea; nausea; trouble urinating; fast, slow, pounding, or irregular heartbeat; numbness or tingling in hands or feet; fever, chills, sore throat, seizures, ringing in the ears, yellowing of the skin or eyes, unusual weakness, unusual bleeding or bruising.

Other: Trouble sleeping, constipation, vomiting, itching, rash, abdominal pain, back pain, blurred vision, abnormal dreams, muscle cramps.

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your health care provider if you are taking:

• antacids such as Maalox, Mylanta, Tums and sucralfate (Carafate) (take them at least 2 hours before or after this medicine)
• antibiotics such as amikacin (Amikin), gentamicin (Garamycin), kanamycin (Kantrex), neomycin, streptomycin, netilmicin (Netromycin), clarithromycin (Biaxin), erythromycin (Ery-Tabs, E.E.S., Eryc), troleandomycin (Tao), tobramycin (Nebcin), rifampin (Rifadin, Rimactane), rifabutin (Mycobutin), and chloramphenicol (Chloromycetin)
• antidepressant medicines such as fluoxetine (Prozac), fluvoxamine (Luvox), and nefazodone (Serzone)
• antifungals such as clotrimazole (Mycelex), fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral)
• anti-HIV medicines such as indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), and saquinavir (Fortovase, Invirase)
• antiseizure medicines such as carbamazepine (Tegretol), phenobarbital, and phenytoin (Dilantin)
• bromocriptine (Parlodel)
• calcium channel blockers such as diltiazem (Cardizem, Dilacor), nifedipine (Procardia, Adalat), and verapamil (Calan, Isoptin, Verelan)
• cisplatin (Platinol)
• danazol (Danocrine)
• diuretics (water pills) such as amiloride (Midamor), spironolactone (Aldactone), or triamterene (Dyrenium)
• ethinyl estradiol (Estinyl)
• immunosuppressant medicine such as cyclosporine (Sandimmune) and sirolimus (Rapamune)
• medicines to treat stomach acid such as cimetidine (Tagamet) omeprazole (Prilosec)
• methylprednisolone (Depo-Medrol, Solu-Medrol)
• metoclopramide (Reglan)
• potassium supplements such as K-Dur and Klor-Con
• St. John's wort
• vaccines.

The effects of this medicine may be dangerously increased if you drink grapefruit juice or eat grapefruit. Discuss this with your health care provider.

Keep a list of all your medicines (prescription, nonprescription, supplements, natural remedies, and vitamins) with you. Be sure that you tell all health care providers who treat you about all the products you are taking.

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your health care provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.