Generic Name: tacrolimus (oral and injection) (ta KROE li mus)
Brand Names: Astagraf XL, Envarsus XR, Prograf
Medically reviewed by P. Thornton, DipPharm. Last updated on Jan 28, 2019.
What is Prograf?
Prograf (tacrolimus) weakens your body's immune system, to help keep it from "rejecting" a transplanted organ such as a kidney. Organ rejection happens when the immune system treats the new organ as an invader and attacks it.
Prograf is a prescription medicine and is used together with other medicines to prevent your body from rejecting a heart, liver, or kidney transplant.
Prograf is supplied as oral capsules, granules for oral suspension, and as an injection for intravenous use.
Prograf may increase your risk of developing a serious infection, lymphoma, or other cancers. Talk with your doctor about the risks and benefits of using this medicine.
Call your doctor right away if you have any signs of infection such as fever, chills, flu symptoms, cough, skin sores, or muscle aches.
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.
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.
Prograf can harm your kidneys, and this effect is increased when you also use certain other medicines harmful to the kidneys. Before using this medicine, tell your doctor about all other medicines you use. Many other drugs (including some over-the-counter medicines) can be harmful to the kidneys.
Before taking this medicine
Using Prograf may increase your risk of developing serious infections or certain types of cancer, such as lymphoma or skin cancer. Your risk may be higher if you are treated over long periods of time with drugs that weaken the immune system. Ask your doctor about this risk and about symptoms to watch for.
Some people taking Prograf after a kidney transplant have developed diabetes. This effect has been seen most commonly in people who are Hispanic or African-American.
To make sure this medicine is safe for you, tell your doctor if you have ever had:
kidney or liver disease;
a heart rhythm disorder or long QT syndrome;
if you take heart rhythm medication; or
if you use other medications that can weaken your immune system.
Both men and women using this medicine should use effective birth control to prevent pregnancy. Tacrolimus can harm an unborn baby or cause birth defects if the mother or father is using this medicine.
If you are pregnant, your name may be listed on a pregnancy registry to track the effects of tacrolimus on the baby.
You should not breast-feed while you are using Prograf.
How should I take Prograf?
Use Prograf exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.
You may receive an injection of Prograf shortly after your transplant. The injection is given until you are ready to take the oral form of this medicine.
Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.
Take this medicine at the same time each day, with a full glass of water. Swallow the capsule whole and do not crush, chew, break, or open it.
You may take Prograf with or without food, but take it the same way each time.
Your dose needs may change if you switch to a different brand, strength, or form of this medicine. All forms of tacrolimus are not equivalent and may not have the same dose or schedule. Avoid medication errors by using only the form and strength your doctor prescribes.
You will need frequent medical tests, and your blood pressure will need to be checked often.
Store at room temperature away from moisture and heat.
What happens if I miss a dose?
For Prograf: Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose.
Do not take two doses at one time.
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?
Do not receive a "live" vaccine while using Prograf, or you could develop a serious infection. Live vaccines include measles, mumps, rubella (MMR), rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.
Grapefruit may interact with tacrolimus and lead to unwanted side effects. Avoid the use of grapefruit products.
Avoid drinking alcohol. It may increase your risk of side effects.
Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.
Prograf could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.
Prograf side effects
Get emergency medical help if you have signs of an allergic reaction to Prograf: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
You may get infections more easily, even serious or fatal infections. Stop taking this medicine and call your doctor right away if you have signs of infection such as: fever, chills, flu symptoms, cough, sweating, painful skin sores, skin warmth or redness, or muscle aches.
Also call your doctor at once if you have:
general ill feeling, pain or swelling near your transplanted organ;
confusion, change in mental status, vision changes, seizure (convulsions);
numbness or tingly feeling;
little or no urination, swelling in your feet or ankles;
fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
high blood pressure - severe headache, pounding in your neck or ears;
high blood sugar - increased thirst, increased urination, hunger, fruity breath odor, nausea, loss of appetite, drowsiness, confusion;
high potassium level - nausea, weakness, chest pain, irregular heartbeats, loss of movement;
low magnesium or phosphate - bone pain, jerky muscle movements, muscle weakness or limp feeling, slow reflexes;
low red blood cells (anemia) - pale skin, unusual tiredness, feeling light-headed or short of breath, cold hands and feet; or
signs of stomach bleeding - bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds.
Common Prograf side effects may include:
infections, anemia, weakness;
high blood sugar, low levels of phoshate, potassium, or magnesium;
tremors or shaking;
headache, general pain;
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.
What other drugs will affect Prograf?
Tacrolimus can harm your kidneys, especially if you also use certain medicines for infections, cancer, osteoporosis, bowel disorders, or pain or arthritis (including aspirin, Tylenol, Advil, and Aleve).
Tell your doctor about all your current medicines. Many drugs can interact with tacrolimus, especially:
antibiotic, antifungal, or antiviral medicines; or
heart or blood pressure medication, such as a diuretic or "water pill".
This list is not complete and many other drugs may interact with Prograf. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.
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.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Copyright 1996-2019 Cerner Multum, Inc. Version: 9.01.
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