Tacrolimus

What is tacrolimus?

Tacrolimus is a medicine called an immunosuppressant. An immunosuppressant weakens the immune system. It is used to prevent rejection of transplanted organs, such as the kidney, heart, lung, liver, and small bowel. It is also used to prevent and help treat graft versus host disease (GVHD) in bone marrow and stem cell transplant patients. Tacrolimus may also be used to treat other conditions.

You may hear tacrolimus called by its brand name, Prograf. It is also known as FK506 or FK. Tacrolimus comes in capsule, suspension, and injectable forms.

Before giving tacrolimus to your child

Tell your doctor if your child has ever reacted to tacrolimus or any other medicines. Talk with the doctor or pharmacist if your child has any of the following conditions. Precautions may need to be taken with this medicine if your child has:

• infection or recent exposure to infections, such as chickenpox
• high blood pressure, also known as hypertension
• kidney or liver problems

How should you give your child tacrolimus?

Follow these instructions when giving your child tacrolimus:

• Give your child tacrolimus exactly as your doctor or pharmacist tells you to, even if your child seems well.
• Talk to your child's doctor before you stop giving this medicine for any reason.
• Give your child tacrolimus at the same times every day. Doses are usually given 12 hours apart.
  
• Sometimes they can be given eight hours apart. Your doctor or pharmacist will tell you how often to give your child tacrolimus.
• You may give tacrolimus with food. Try to keep the type and amount of food the same. Changes in your child's diet may change how tacrolimus is absorbed.
• Give the same type of drink, such as apple juice, with each dose of tacrolimus. Do not give grapefruit, pomelos or tangelos or their juices while your child is taking tacrolimus.
• If giving capsules, they should be swallowed whole.
• If giving the liquid form, shake the bottle well before measuring each dose. Measure the suspension with the special spoon or syringe that the pharmacist gave you.
• Tacrolimus can also be given by needle into your child's vein. Your child will get this medicine in the hospital clinic or the nursing unit.

What should you do if your child misses a dose of tacrolimus?

• Give the missed dose as soon as you remember.
• If it is almost time for the next dose, skip the missed dose. Give the next dose at the regular time.
• Do not give your child two doses to make up for one missed dose.

What should you do if your child throws up after you give tacrolimus?

If your child vomits a dose within 30 minutes of taking tacrolimus, repeat the dose. If it is longer than 30 minutes, do not repeat the dose but make a note that the dose was vomited. The dose should not be repeated more than once.

How long does tacrolimus take to work?

It may take several weeks for tacrolimus to make a difference in your child's condition.

What are the possible side effects of tacrolimus?

Your child may have some of these side effects while they take tacrolimus. Check with your child's doctor if your child continues to have any of these side effects, and they do not go away, or they bother your child:

• upset stomach, vomiting (throwing up), or diarrhea
• mild headache
• trembling or shaking of hands, called tremors
• leg cramps

Call your child's doctor during office hours if your child has any of these side effects:

• unusual tiredness or weakness?
• unexplained nervousness
• numbness or tingling of hands, feet, or lips
• blurry vision or changes in eyesight
• yellowing of the skin or eyes
• frequent urge to urinate
• decrease in the amount of urine being made
• skin rash
  

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's doctor right away or take your child to Emergency if your child has any of these side effects:

• fever, chills
• cough or sore throat
• blood in urine, difficulty urinating, or pain with urination
• severe headache
• seizures
• confusion
• shortness of breath or trouble breathing
• chest pain
• fast or irregular heartbeat
• severe stomach pain
  

What safety measures you should take when your child is using tacrolimus?

Because tacrolimus weakens your child's immune system, it increases your child's chances of getting an infection. Your child can take the following precautions to prevent infections:

• Avoid people with infections, such as a cold or the flu.
• Avoid places that are crowded with large groups of people.
• Be careful when brushing or flossing your child's teeth.
• You or your child shouldn't touch your child's eyes or inside their nose without washing you and your child's hands first.
• Your child's nurse will review with you what to do in case of fever.

Tacrolimus may make your child's skin more likely to sunburn. Make sure your child covers their skin and head with clothing and a hat when outside. Your child should also use sunscreen. Look for a sunscreen that says it protects against the sun's ultraviolet rays, called UVA and UVB rays. The sunscreen should have a sun protection factor, called SPF, of at least 30. Ask your pharmacist to help you pick the right sunscreen.

Your child may not have grapefruits, grapefruit juice, or tangelos. These may make the tacrolimus level in your child's blood go up and increase the chance of having side effects.

It is important to read the contents of mixed fruit juices to ensure that they do not contain grapefruit juice.

There are some medicines that should not be taken together with tacrolimus or in some cases the dose of tacrolimus or the other medicine may need to be adjusted. It is important that you tell your doctor and pharmacist if your child takes any other medicines, such as prescription, over the counter, or herbal. These include:

• calcium channel blockers, such as diltiazem
• cholesterol medicines, such as atorvastatin
• antifungals, such as fluconazole
• other immunosuppressants
• anti-seizure medicines, such as phenytoin or carbamazepine
• HIV medicines, such as ritonavir
• macrolide antibiotics, such as clarithromycin

Vaccinations

Your child should not receive any immunizations (vaccines) without your child's doctor's approval. Your child or anyone else in your household should not get oral polio vaccine while your child is being treated with tacrolimus. Tell your child's doctor if anyone in your household has recently received oral polio vaccine. Your child should avoid contact with anyone who has recently received this vaccine. Other live vaccines that your child should not get include measles, mumps, and rubella (MMR), and the chicken pox vaccine.

After your child stops receiving tacrolimus it may still cause side effects. These delayed effects may include certain types of cancer. Your child's doctor will be able to give you more details about this.

Check with your doctor immediately if any of the following signs occur even after tacrolimus treatment has stopped:

• yellow eyes or skin
• blood in urine or stools
• black tarry bowel movements
• unusual bleeding or bruising
• stomach, lower back, or side pain
• cough or a hoarse voice
• diarrhea
  

What other important information you should know about tacrolimus?

• Keep a list of all medicines your child is on and show the list to the doctor or pharmacist.
• Do not share your child's medicine with others. Do not give anyone else's medicine to your child.
• Make sure you always have enough tacrolimus to last through weekends, holidays, and vacations. Call your pharmacy at least 2 days before your child runs out of medicine to order refills.
• Tell the doctor or dentist that your child is taking tacrolimus before your child has any operation, whether on the teeth or an emergency treatment.
• Keep all appointments at the clinic or doctor's office so that the doctor can check your child's response to tacrolimus. The doctor may need to change the dose so that your child is getting the right amount. The doctor may order blood tests to check for liver or kidney problems.
• Blood levels of tacrolimus are checked routinely. On days that your child is having a level checked, do not give the morning dose until the blood has been drawn.
  
• There is a chance that tacrolimus may cause birth defects if it is taken at the time of conception or if it is taken during pregnancy. If your child is sexually active it is best that they use some kind of birth control while receiving tacrolimus. Tell the doctor right away if your child may be pregnant.
• Keep tacrolimus at room temperature in a cool, dry place. Do not store it in the bathroom or kitchen.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
  

Keep tacrolimus out of your child’s sight and reach and locked up in a safe place. If your child takes too much tacrolimus, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.