Advagraf

  • Take tacrolimus one hour before food or two to three hours after food.
  • Keep your regular appointments with your doctor so your progress can be checked.
  • When you collect your prescriptions, check that you have been given the same brand of tacrolimus as before. If the appearance is not the same as usual or if the dosage instructions have changed, speak with your doctor or pharmacist.

About tacrolimus

Type of medicine Immunosuppressant
Used for Preventing rejection of new organs following a transplant operation
Also called Adoport®
Advagraf®
Prograf®
Modigraf®
Vivadex®
Tacni®
Available as Capsules, prolonged-release capsules, granules for oral suspension, and injection

The body produces white blood cells called lymphocytes to fight infection or foreign substances which have entered the body. Following an organ transplant your body's immune system recognises the new organ as 'foreign' to you and will try to attack it with lymphocytes. Tacrolimus works by stopping the body from producing these lymphocytes and prevents the attack on the transplanted organ.

Tacrolimus is also available as an ointment which is used in the treatment of eczema. There is a separate information leaflet available about this called Tacrolimus (topical).

Before taking tacrolimus

Before taking tacrolimus make sure your doctor or pharmacist knows:

  • If you are pregnant, trying for a baby or breast-feeding.
  • If you have liver or heart problems.
  • If you have recently taken a drug called ciclosporin.
  • If you have ever had an allergic reaction to tacrolimus or any other medicine, especially the antibiotics erythromycin, clarithromycin, azithromycin and telithromycin.
  • If you are taking any other medicines, including those available to buy without a prescription, herbal and complementary medicines.

How to take tacrolimus

  • Before starting this treatment, read the manufacturer's printed information leaflet from inside the pack.
  • Take tacrolimus exactly as your doctor has told you.
  • Take tacrolimus when your stomach is empty. This means an hour before food or 2-3 hours after food.
  • It is important that you do not change the brand of tacrolimus that you are taking except on the advice of your transplant specialist. Different brands release different amounts of tacrolimus and if you swap formulations this can either stop the medicine from working properly or lead to side-effects.
    • Adoport® is an immediate-release formulation that is taken twice daily, once in the morning and once in the evening.
    • Prograf® is an immediate-release formulation that is taken twice daily, once in the morning and once in the evening.
    • Modigraf® granules are used to prepare an immediate-release suspension which is taken twice daily, once in the morning and once in the evening. You should dissolve or mix the granules in water before taking. (Do not use cups or spoons that are made of PVC (polyvinylchloride) when you prepare the suspension because the active substance sticks to this kind of plastic).
    • Advagraf® is a prolonged-release formulation that is taken once daily in the morning. Swallow the capsules whole - do not chew or open them.
    • Vivadex® is an immediate-release formulation that is taken twice daily, once in the morning and once in the evening.
  • Try to take tacrolimus at the same times each day to avoid missing any doses. If you forget to take a dose, take it as soon as you remember unless it is nearly time for your next dose, in which case leave out the missed dose. Do not take two doses together to make up for a forgotten dose.
  • Do not drink grapefruit juice while you are taking tacrolimus as it can increase the levels of tacrolimus in your body.
  • Do not stop taking tacrolimus unless your doctor tells you to do so. Stopping taking tacrolimus will increase the risk of your transplanted organ being rejected.

Getting the most from your treatment

  • Keep your regular appointments with your doctor so your progress can be checked. While you are taking tacrolimus, your doctor will want to carry out blood and urine tests. From the results of these, your doctor will decide whether you need to adjust the dose you are taking. Your blood pressure, eyes and heart function will also be checked.
  • If you buy any medicines (including painkillers and herbal remedies), check with your pharmacist which medicines are safe for you to take with tacrolimus.
  • Tacrolimus may affect your vision and slow your reactions. Make sure your reactions are normal before driving, operating machinery or doing other jobs which could be dangerous if you were not fully alert or able to see clearly. Do not drink alcohol as it may increase these effects.
  • You should protect yourself from the sun and ultraviolet light while you are taking tacrolimus. Avoid strong sunlight and sun beds and use a sunscreen with a high sun protection factor (at least SPF 15). This is because tacrolimus could increase the risk of skin cancer.
  • If you have diabetes this medicine may affect your blood sugar levels. Test your urine or blood regularly and report any extreme changes to your doctor.
  • Let your doctor know if you have diarrhoea for more than one day while you are taking tacrolimus. This is because the amount of tacrolimus in your blood may change when you have diarrhoea and your dose may need to be changed.
  • Women must avoid getting pregnant while taking tacrolimus. Hormonal contraceptives such as the 'pill' may be less effective with tacrolimus. Ask your doctor about suitable alternative methods of contraception.
  • While you are taking tacrolimus and for 6 months after you stop treatment, do not have any immunisations (vaccinations) without talking to your doctor first. Tacrolimus lowers your body's resistance to infection and there is a chance that you may get an infection from the vaccine.
  • If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking tacrolimus.

Can tacrolimus cause problems?

Your doctor will have discussed with you the possibility of unwanted side-effects and how you will be regularly checked for signs of these. You will also have been told that you may become more prone to infections. Some of the more common unwanted effects are listed below. Let your doctor know if any of the following continue or become troublesome, or if you experience any other symptoms which you are concerned about or think may be due to this medicine.

Side-effects What can I do if I experience this
Headache Ask your pharmacist to recommend a suitable painkiller. If the headache continues, speak with your doctor
Diarrhoea Drink plenty of liquid to replace lost fluids. If the diarrhoea continues for more than one day, speak with your doctor or clinic
Feeling or being sick, abdominal pain, indigestion, flatulence (wind) Stick to simple foods and avoid spicy foods
Dizziness, blurred vision If this happens, do not drive or use tools or machines. Do not drink alcohol
Constipation Try to eat a well balanced diet containing plenty of fibre and drink 6-8 glasses of water each day
Difficulty sleeping, trembling, anxiety, confusion, mood changes, numbness in the hands or feet, ringing sound in your ears, cough and flu-like symptoms, pain in joints and muscle cramps If any of these become troublesome, discuss them with your doctor

How to store tacrolimus

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.