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Tacrolimus (Prograf ®) is an immunosuppressant drug used to prevent and treat organ rejection in children who have had liver transplants. It is used for long-term immunosuppression.
Studies suggest that children generally tolerate tacrolimus well; they are less likely to suffer from hypertension or need steroid or insulin treatments. Graft loss from acute or chronic rejection is extremely rare under tacrolimus.
The use of this potent medication should only be managed by a transplant surgeon familiar with it.
Tacrolimus prevents rejection by inhibiting T lymphocyte cells, specific cells of the immune system.
Tacrolimus mediation is taken by mouth or given by injection. The oral medication is available in 1-mg (white) capsules and 5-mg (pink) capsules.
Take tacrolimus on a regular schedule, at the same time each day. Usually tacrolimus is taken twice a day, 12 hours apart, such as at 8 a.m. and 8 p.m. Occasionally it is taken only once a day (usually in the morning and at the same time each day) or as often as three times a day (8 hours apart, such as at 7 a.m., 3 p.m., and 11 p.m.).
Tacrolimus can be taken with or without food.
Check with your transplant coordinator if you want to change the time(s) that your child takes tacrolimus. If you are traveling to a different time zone, contact your coordinator for advice.
If your child misses a dose of tacrolimus, call your coordinator for advice. If fewer than three hours have passed since the dose was missed, your coordinator may tell you to give the missed dose and get back on schedule. If more than three hours have passed since the missed dose, the coordinator may advise you otherwise. Taking doses too close to each other may produce toxic effects.
If your child misses several doses of tacrolimus due to vomiting, surgery, inability to swallow, or other reasons, he or she can receive the medication intravenously. Tell your transplant coordinator if your child is having trouble taking this medicine.
Common side effects of tacrolimus include:
Other common side effects include:
Rare side effects include:
If any of these side effects continues or becomes bothersome, inform your doctor immediately.
Magnesium oxide, sodium bicarbonate, Sucralfate, or other antacids should not be taken within two hours of taking tacrolimus. For example, if your child takes tacrolimus at 8:00 a.m., magnesium oxide should not be given until 10:00 a.m. or later.
Many medications may affect tacrolimus absorption. For this reason, it is extremely important that you notify your coordinator of any medication changes. If your child needs to take a medication that may affect tacrolimus absorption or metabolism, your transplant surgeon may recommend that the tacrolimus dose be changed. Also, the surgeon may order more frequent blood tests to monitor tacrolimus levels.
Be sure to tell your doctor or pharmacist about any prescription or over- the-counter medication your child is taking, so you can be warned of interactions and prevent them.
Store tacrolimus at room temperature.
Your child should receive tacrolimus exactly as prescribed, at the same times each day. Never stop this medication unless a transplant surgeon or your transplant coordinator advises you to do so.
One exception is the morning of a scheduled clinic visit. At this time, your child should not take the morning dose of tacrolimus. Bring a dose to the clinic with you, and your child can take his or her medication after blood is drawn.
We recommend that patients wear a medical alert bracelet or pendant (such jewelry marked under the name Medic Alert) that says "taking immunosuppressant".
Not all pharmacies stock tacrolimus. Call your pharmacist at least five working days before you need to fill a prescription, to make sure the medication will be available.
Tacrolimus can be obtained through Falk Pharmacy, Monday through Friday, 9:00 a.m. to 5:00 p.m.
Learn more about other Intestine Transplant Drugs.
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UPMC Children’s Hospital of Pittsburgh
One Children’s Hospital Way
4401 Penn Ave.
Pittsburgh, PA 15224
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