Tacrolimus

Please note: these are basic guidelines, refer to your doctor for a professional medical opinion.

Popular brand names:

Advagraf, Prograf, Protopic

Drug group:

Immunosuppressant drug

Prescription needed?

Yes

What does it do?

Tacrolimus is an immunosuppressant drug – it suppresses the immune system, either systemically (oral) or locally (ointment):

• It is used in many types of organ transplants to help prevent rejection, usually in combination with other immunosuppressants
• Tacrolimus may also be used topically to treat moderate to severe eczema when other treatments are unsuitable or unsuccessful

How should it be used?

• Tacrolimus should not be taken by people who are allergic to any macrolide antibiotic
• Oral preparations should be taken on an empty stomach or 2–3 hours after a meal
• Avoid consuming high-potassium foods and grapefruit juice with oral tacrolimus

What is the typical dosage?

Your doctor will recommend a dosage tailored to your need, but typically:

• Oral and injected preparations: 1–2 x daily, dose is calculated individually
• Topical preparation: initially 1–2 x daily, then 2 x weekly when eczema improves; adults 0.1% or 0.03% ointment, children 0.03% ointment

How quickly will it start to work?

Oral/injection 12 hours, ointment 1–2 weeks   
                  

How long will the effects last?

2–4 days 

When should I stop using it?

Do not stop the drug without consulting your doctor       
                          

Is it safe for prolonged use?

Long-term use increases susceptibility to certain conditions:

Oral/injected: kidney/liver dysfunction, infections, skin/lymphoid cancers, high blood pressure, and diabetes - regular blood tests for kidney/liver function, blood pressure checks, and blood glucose may be necessary. Topical: herpes skin infections (e.g. cold sores), skin cancer.

What are the possible side effects?

The following have been reported:

• Topical: local irritation, rash, pins and needles (paraesthesia)
• Oral: nausea, diarrhoea, sleep problems, drowsiness, headache, tremor, paraesthesia
• Report to your doctor before taking your next dose if you experience: spontaneous bruising or bleeding, fever, sore throat

What other considerations are important?

Dosage may be adjusted by your doctor under certain conditions.

• Certain health problems: kidney/liver problems, lactose intolerance, peanut/soya allergy, current/planned pregnancy
• Other medicines: St John’s wort, vaccines
• Pregnancy and breast-feeding: Safety not established
• Children: For specialist use only, reduced strength ointment can be used
• Over 60: No special problems
• Driving and hazardous work: Caution, systemic forms may cause drowsiness
• Alcohol: Avoid, increased risk of drowsiness (oral), or skin irritation (topical)
• Sunlight and sunbeds: Avoid prolonged/unprotected exposure, increased risk of skin cancer