Generic Name: tacrolimus (oral and injection) (ta KROE li mus)
Brand Name: Astagraf, Hecoria, Prograf
What is Prograf?
Prograf (tacrolimus) lowers your body's immune system. The immune system helps your body fight infections. The immune system can also fight or "reject" a transplanted organ such as a liver or kidney. This is because the immune system treats the new organ as an invader.
Prograf is used together with other medicines to prevent your body from rejecting a heart, liver, or kidney transplant.
Prograf may also be used for purposes not listed in this medication guide.
Important information about Prograf
Prograf may increase your risk of developing serious infections, cancer, or transplant failure. Talk with your doctor about the risks and benefits of using this medication.
You will need regular medical tests to be sure Prograf is not causing harmful effects. Do not miss any follow up visits to your doctor for blood or urine tests. Avoid being near people who are sick or have infections.
Prograf can harm your kidneys, and this effect is increased when you also use certain other medicines harmful to the kidneys. Before using Prograf, tell your doctor about all other medicines you use. Many other drugs (including some over-the-counter medicines) can be harmful to the kidneys.
Call your doctor right away if you have symptoms of a serious brain infection, such as a change in your mental state, problems with speech or walking, or decreased vision. These symptoms may start gradually and get worse quickly.
Before taking Prograf
You should not use Prograf if you are allergic to tacrolimus or hydrogenated castor oil, or if you have used cyclosporine (Neoral, Sandimmune, Gengraf) within the past 24 hours.
Prograf can lower blood cells that help your body fight infections, or cause your body to produce too much of a certain type of white blood cells. This can lead to serious and sometimes fatal conditions, including cancer, a severe brain infection that can lead to disability or death, or a virus that can cause failure of a transplanted kidney.
Using Prograf may increase your risk of developing skin cancer, especially if you are treated over long periods of time with drugs that weaken the immune system. Talk with your doctor about your specific risk.
Some people taking Prograf after a kidney transplant have developed diabetes. This effect has been seen most often in people who are Hispanic or African-American. Talk with your doctor about your individual risk of diabetes if you have concerns.
To make sure you can safely take Prograf, tell your doctor if you have any of these other conditions:
kidney or liver disease;
heart disease, high blood pressure, high cholesterol or triglycerides (a type of fat in the blood);
if you also use sirolimus (Rapamune); or
if you are using other drugs that weaken your immune system such as cancer medicine or steroids.
FDA pregnancy category C. It is not known whether Prograf will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.
See also: Prograf pregnancy and breastfeeding warnings (in more detail)
Tacrolimus can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using Prograf.
How should I take Prograf?
Take Prograf exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results.
You may receive an injection of Prograf shortly after your transplant. Prograf injection is given until you are ready to take the pill form of Prograf.
The Prograf capsule is usually taken every 12 hours. Take the medicine at the same time each day. You may take Prograf with or without food, but take it the same way each time.
You will need regular medical tests to be sure this medication is not causing harmful effects. Visit your doctor regularly. Do not miss any follow up visits to your doctor for blood or urine tests.
Store at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking Prograf?
Grapefruit and grapefruit juice may interact with Prograf and lead to potentially dangerous effects. Do not use grapefruit products while you are taking Prograf.
Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.
Avoid exposure to sunlight or tanning beds. Prograf can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.
Do not receive a "live" vaccine while using Prograf. The vaccine may not work as well during this time, and may not fully protect you from disease. Live vaccines include measles, mumps, rubella (MMR), Bacillus Calmette-Guérin (BCG), oral polio, rotavirus, smallpox, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.
Prograf side effects
Get emergency medical help if you have any of these signs of an allergic reaction to Prograf: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have a serious side effect such as:
fever, chills, body aches, flu symptoms, sores in your mouth and throat;
change in your mental state, problems with speech or walking, decreased vision (may start gradually and get worse quickly);
pale or yellowed skin, dark colored urine, confusion or weakness;
feeling light-headed or short of breath, rapid heart rate, trouble concentrating;
pain in the lower back or side, blood in your urine, pain or burning when you urinate;
urinating less than usual or not at all;
dry cough, cough with mucus or blood, sweating, wheezing, gasping for breath, chest pain;
tremors (shaking), seizure (convulsions);
high potassium (slow heart rate, weak pulse, muscle weakness, tingly feeling);
low magnesium (jerky muscle movements, muscle weakness or limp feeling, slow reflexes);
high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, chest pain, shortness of breath, uneven heartbeats); or
high blood sugar (increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, weight loss).
Less serious Prograf side effects may include:
nausea, stomach pain, diarrhea, constipation;
sleep problems (insomnia); or
swelling in your hands or feet.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
See also: Prograf side effects (in more detail)
What other drugs will affect Prograf?
Prograf can harm your kidneys. This effect is increased when you also use other medicines harmful to the kidneys, such as: chemotherapy, antiviral medication, pain or arthritis medicine, injected antibiotics, or medicines to treat a bowel disorder or prevent organ transplant rejection. You may need dose adjustments or special tests if you have recently used any of these medications.
Many drugs can interact with Prograf. Below is just a partial list. Tell your doctor about all other medicines you use, especially:
other medicines to prevent rejection of a transplanted organ;
St. John's wort;
antacids such as Amphojel, Maalox, Mylanta, Rolaids, Rulox, and others;
an antibiotic such as azithromycin (Zithromax, Zmax, Z-Pack), clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), levofloxacin (Levaquin), rifabutin (Mycobutin), rifampin (Rifadin, Rifater, Rifamate), and others;
an antidepressant such as desipramine (Norpramin) or nefazodone;
antifungal medication such as caspofungin (Cancidas), clotrimazole (Mycelex Troche), itraconazole (Sporanox), ketoconazole (Nizoral), posaconazole (Noxafil), or voriconazole (Vfend);
a barbiturate such as phenobarbital (Solfoton);
birth control pills or hormone replacement;
heart or blood pressure medication such as amiodarone (Cordarone, Pacerone), amlodipine (Norvasc, Caduet, Exforge, Lotrel, Tekamlo, Tribenzor, Twynsta, Amturnide), diltiazem (Cardizem, Cartia, Dilacor, Diltia, Diltzac, Taztia, Tiazac), dronedarone (Multaq), nifedipine (Nifedical, Procardia), quinidine (Quin-G), verapamil (Calan, Covera, Isoptin, Verelan, Tarka), and others;
HIV/AIDS medication such as atazanavir (Reyataz), efavirenz (Sustiva, Atripla), fosamprenavir (Lexiva), nelfinavir (Viracept), ritonavir (Norvir, Kaletra), and others;
the hepatitis C medications boceprevir (Victrelis) or telaprevir (Incivek);
seizure medication such as carbamazepine (Carbatrol, Equetro, Tegretol), phenytoin (Dilantin), and others;
steroid medicine such as dexamethasone (Cortastat, Dexasone, Solurex, DexPak) or methylprednisolone (Medrol); or
stomach acid reducers such as cimetidine (Tagamet), lansoprazole (Prevacid), or omeprazole (Prilosec, Zegerid).
This list is not complete and there are many other drugs that can interact with Prograf. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.
More Prograf resources
- Prograf Prescribing Information (FDA)
- Prograf Advanced Consumer (Micromedex) - Includes Dosage Information
- Prograf Monograph (AHFS DI)
- Prograf MedFacts Consumer Leaflet (Wolters Kluwer)
- Tacrolimus Prescribing Information (FDA)
- Tacrolimus Professional Patient Advice (Wolters Kluwer)
- tacrolimus Intravenous Advanced Consumer (Micromedex) - Includes Dosage Information
- Astagraf XL extended-release capsules MedFacts Consumer Leaflet (Wolters Kluwer)
- Astagraf XL Prescribing Information (FDA)
- Hecoria Prescribing Information (FDA)
- Hecoria MedFacts Consumer Leaflet (Wolters Kluwer)
Compare Prograf with other medications
Where can I get more information?
- Your pharmacist can provide more information about Prograf.
- Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Prograf only for the indication prescribed.
Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.
Copyright 1996-2013 Cerner Multum, Inc. Version: 6.02. Revision Date: 2013-09-15, 7:48:33 PM.