INFORMATION SHEET

Tacrolimus (Prograf)

Why am I being prescribed tacrolimus?

Tacrolimus (trade name Prograf) is licensed to prevent rejection of organs after transplantation but it may be helpful in the treatment of certain types of rheumatic disease, including systemic lupus erythematosus (SLE). It reduces the activity of the body's immune system (the body's own defence system), so it is always used with care.

When and how do I take tacrolimus?

Tacrolimus usually taken in capsule form twice a day. The capsules should be taken with a glass of water. Do not crush or chew the capsules. They should be swallowed whole. They should be taken either one hour before or two to three hours after food. Grapefruit or grapefruit juice should not be consumed by anyone on tacrolimus. Your doctor will advise you about the correct dose.

How long will tacrolimus take to work?

Tacrolimus does not work immediately. It may be up to 3 months before you notice any benefit.

What are the possible risks or side-effects?

The most common side-effects of tacrolimus are indigestion (which may rarely be a sign of a stomach ulcer), drowsiness (if affected avoid driving or skilled tasks such as operating machinery), palpitations, chest pain, tremor, mood changes, visual or hearing disturbance, shortness of breath, muscle or joint pain or rashes. Tacrolimus can also affect your liver and may increase blood pressure. It may affect blood sugar levels so if you are diabetic you should test more frequently. It can also affect your blood count (one of the effects is that fewer blood cells are made) and can make you more likely to develop infections. Rarely, thickening of the heart muscle has been associated with tacrolimus.

If you develop a sore throat or other infection, a fever, unexplained bruising or bleeding, or if you develop any other unexpected new symptoms after starting tacrolimus, you should report to your doctor or Rheumatology nurse specialist immediately. If any of these symptoms are severe, you should stop tacrolimus and see your doctor immediately.

If you have not previously had chickenpox, but come into contact with someone who has chickenpox or shingles, or if you develop chickenpox or shingles, you should stop tacrolimus and see your doctor immediately as you may need special treatment. This is because chickenpox and shingles can be severe in people on treatment such as tacrolimus which has effects on the immune system. Therefore you may require antiviral treatment.

There may be a slightly increased risk of certain types of cancer with tacrolimus. Discuss this with your doctor. Because of the small increase in risk of skin cancer, you should avoid exposure to strong sunlight and protect your skin with sunblock or sunscreen.

Rarely, people may be allergic to tacrolimus. If this is the case with you, the drug will have to be stopped. Symptoms of allergy include rash, wheezing, shortness of breath, and swelling of the face, lips, tongue or throat.

Do I need any special checks while on tacrolimus?

Tacrolimus can affect the blood count, liver function or electrolytes (salts). Occasionally, it may be associated with high blood pressure. You will therefore need the following special checks:

You may be asked to keep a record booklet with your blood test results. Bring this with you when you visit your general practitioner or the hospital. You must not take tacrolimus unless you are having regular checks.

Can I take other medicines along with tacrolimus?

Tacrolimus may be prescribed along with other drugs in treating your condition. Some drugs interact with it so you should discuss any new medications with your doctor before starting them, and you should always tell any other doctor, nurse or dentist treating you that you are taking tacrolimus and if you buy any ‘over the counter’ medicines without a prescription you should check with the pharmacist.

Tacrolimus is not a painkiller. So if you are on a non-steroidal anti-inflammatory drug (NSAID) or painkillers you may continue to take these, unless your doctor advises otherwise. In some circumstances, other immunosuppressive drugs may be prescribed with tacrolimus. If this applies to you, discuss the additional precautions with your doctor.

Can I have immunisations while on tacrolimus?

It is recommended that you should not be immunised with 'live' vaccines such as yellow fever. However, in certain situations a live vaccine may be necessary (for example rubella immunisation in women of childbearing age), in which case your doctor will discuss the possible risks and benefits of the immunisation with you. Pneumovax and yearly flu vaccines are safe and recommended.

For more information about vaccines, please visit the website: http://www.cambridge-arthritis.org.uk/vaccines.php

May I drink alcohol while taking tacrolimus?

If you drink alcohol you should only drink small amounts (e.g. 1 unit/per day) because tacrolimus can affect your liver. Do not have several drinks on the same day, even if your total intake during the whole week remains low.

What if I am thinking of getting pregnant?

It is very important that you do not become pregnant and you must avoid breastfeeding whilst on tacrolimus, So you must use adequate barrier methods of contraception. Tacrolimus may interfere with the oral contraceptive pill so you must use alternatives. If you are planning a family, you should discuss this with your doctor several months beforehand as you will need to stop tacrolimus in advance.

Where can I obtain further information?

If you would like any further information about tacrolimus, or if you have any concerns about your treatment, you should discuss this with your doctor, or telephone the Rheumatology advice line on 01223 217398. Remember to keep all medicines out of reach of children.

PLEASE NOTE: We have made every effort to ensure that the content of this information sheet is correct, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.

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