Tacrolimus for Renal Transplant

About your medicine

All patients who have a kidney transplant need to take drugs called immuno-suppressants. As the word immuno-suppressant suggests, the function of these drugs is to suppress the immune system, the body’s natural defence system. The aim is to dampen down the immune system enough to stop it rejecting the transplant kidney while still keeping it active enough to fight infections.

Tacrolimus belongs to this group of medicines. It is only available from your doctor.

There are two preparations of tacrolimus, Prograf (twice daily administration), and Advagraf (once daily administration). They are both the same drug, and either can be used safely. However it is most important that you know which one you are taking, that you take it correctly, and do not switch between the two types unless asked to do so by the transplant unit.

You should NOT be vaccinated with some vaccines whilst receiving tacrolimus. (Vaccines are injections that can be given to help prevent you from catching some diseases, for example, polio). For vaccines you can and cannot have, see the vaccine page.

Taking your medicine

The capsules should be removed from the blister immediately before taking and swallowed whole with water. The capsules are best taken one hour before a meal or two hours afterwards ie on an empty stomach.

The total daily dose that you are asked to take should be divided and taken in two doses, 12 hours apart (Prograf), or once daily (Advagraf).

You should AVOID grapefruit and grapefruit juice for one hour before taking tacrolimus because it will affect the tacrolimus.

Take the capsules as your doctor recommended, never change the dose yourself. If you do not take the tacrolimus you will lose your new kidney.

If you forget to take a dose, or accidentally take an extra dose, tell your doctor. You will need to have regular blood samples taken to check that the dose of tacrolimus is right for you; too much can be harmful to your kidney. When you come to clinic do not take your morning dose until after you have had your blood taken.

Unwanted effects

Tacrolimus can cause side effects in some people. The most common side effects with tacrolimus include trembling, headaches, feeling sick, and ‘pins and needles’ in your arms and legs. You should inform your doctor if you suffer from any of these.

You are more likely to develop infections whilst receiving immuno-suppressant therapy and any infections may be worse than normal, so you should report any signs of infection to your doctor.

Some other drugs may cause problems with tacrolimus; these include erythromycin, fluconazole, rifampicin and miconazole. Some herbal remedies may also cause problems, including St John’s wort. This is not a full list so be sure to check with your doctor or pharmacist before taking any other medication along with tacrolimus.

You should avoid sunbathing and use a sunblock in sunny weather. You are recommended to see your doctor about regular skin checks and cervical smears for women. This is because you are more likely to develop skin or cervical cancers which may not be serious if noticed early.

Storing your medicine

Store the capsules in their original packet in a cool, dry place away from children. Capsules should not be taken if they have been out of the aluminium outer wrapper for longer than twelve months. Only remove the capsules from the blister immediately before taking.

You should NOT eat the sachet of silica gel contained within the aluminium wrapper.

All tablets may cause side effects in some people. If you think that you are suffering from a side effect of one of your tablets it is important NOT to stop taking the tablet, but see your doctor who will be able to change that tablet for one which will suit you better.

NKF Controlled Document No. 78, Tacrolimus for Renal Transplant, written 22 April 2000. Last reviewed 10 March 2010.

The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.

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