Tacrolimus is a drug to prevent or treat a rejection response from body after kidney, heart, or liver transplant. Tacrolimus can also be used in the treatment of atopic eczema that cannot be treated with other drugs.
After undergoing an organ transplant procedure, a person is at risk of experiencing a rejection reaction because the immune system perceives the newly transplanted organ as something foreign and dangerous. As a result, the immune system will attack these organs. Tacrolimus will work by suppressing the immune system response. That way, the rejection reaction can be prevented and the symptoms of inflammation will subside.
Tacrolimus trademarks: Prograf, Prograf XL, Protopic
What is Tacrolimus
| group | Prescription drugs |
| Category | Immunosuppressive drugs |
| Benefit | Prevent and treat the body's response to rejection of new organs after heart, kidney, liver, lung, or pancreas transplantation, and treat atopic dermatitis. |
| Used by | Adults and children 2 years old |
| Tacrolimus for pregnant and lactating women | Category C: Animal studies have shown adverse effects on the fetus, but there are no controlled studies in pregnant women. The drug should only be used if the expected benefit outweighs the risk to the fetus. Tacrolimus can be absorbed into breast milk. If you are breastfeeding, do not use this medicine without consulting your doctor first. |
| Medicine Form | Infusion fluids, capsules, ointments |
Precautions Before Using Tacrolimus
Tacrolimus should only be used as prescribed by a doctor. There are several things that must be considered before using this drug, including:
- Tell your doctor about any allergies you have. Tacrolimus should not be given to patients who are allergic to this drug.
- Talk to your doctor if you plan to get vaccinated while on treatment with tacrolimus.
- Tell your doctor if you have or have had cancer, heart disease, kidney disease, liver disease, electrolyte disturbances, infectious disease, hypertension, diabetes, or a heart rhythm disorder, such as QT prolongation syndrome.
- As much as possible, avoid close contact with people with infectious diseases that are easily transmitted, such as the flu or measles, during treatment with tacrolimus, because taking this drug can increase your risk of contracting it.
- Tell your doctor if you are pregnant, breastfeeding, or planning a pregnancy. Use effective contraception to prevent pregnancy during treatment with tacrolimus.
- Limit activities that expose you to direct sunlight during treatment with tacrolimus, as this medicine can make your skin more sensitive to sunlight.
- Tell your doctor if you are taking certain medications, supplements, or herbal products.
- Tell your doctor right away if you have an allergic drug reaction, serious side effect, or overdose after using tacrolimus.
Dosage and Instructions for Use of Tacrolimus
The doctor will determine the dose of tacrolimus based on the form of the drug, the patient's age and weight, and the purpose for which it is used. Here are the dosage details:
Tacrolimus injection or infusion
Purpose: Prevent rejection reactions after heart transplant
- Mature: 10–20 mcg/kg body weight per day, by infusion, for 7 days
- Children: Dosage 30–50 mcg/kgBW per day
Purpose: Prevent rejection reactions after kidney transplant
- Mature: 50–100 mcg/kg, by infusion, for 7 days
- Children: 70–100 mcg/kg body weight per day, by infusion, for 7 days
Purpose: Prevent rejection reactions after liver transplant
- Mature: 10–50 mcg/kg, by infusion, for 7 days
- Children: 50 mcg/kg body weight per day, by infusion, for 7 days.
Tacrolimus capsules or tablets
Purpose: Prevent rejection reactions after kidney transplant
- Mature: 200–300 mcg/kg body weight per day divided into 2 doses
- Children: 300 mcg/kg body weight per day divided into 2 doses
Purpose: Prevent rejection reactions after heart transplant
- Mature: 75 mcg/kg body weight per day divided into 2 doses
- Children: 100–300 mcg/kg body weight per day in 2 divided doses
Purpose: Prevent rejection reactions after liver transplant
- Mature: 100–200 mcg/kg body weight per day divided into 2 doses
- Children: 300 mcg/kg body weight per day divided into 2 doses
Purpose: Treating liver, heart, liver, kidney, pancreas, lung transplant rejection reactions
- Adults and children: 75–300 mcg/kg body weight per day, divided into 2 doses.
Tacrolimus ointment
Purpose: Treating atopic eczema
- Mature: Apply a thin layer on the inflamed area, 2 times a day for 2 weeks.
- Children 2 years old: Apply a thin layer on the inflamed area, 2 times a day for 3 weeks.
How to Use Tacrolimus Correctly
Follow the doctor's recommendations and read the instructions for use listed on the packaging before using tacrolimus. Do not increase or decrease the dose, and do not use the drug for longer than the time recommended by your doctor.
Tacrolimus in the form of intravenous fluids will be given by a doctor or medical officer under the supervision of a doctor at the hospital. Drug administration is carried out after organ transplantation.
Tacrolimus capsules can be taken before or after meals. Swallow the capsule whole with a glass of water and do not split or crush the capsule. It is recommended to take tacrolimus capsules at the same time every day for maximum benefits.
For patients who forget to take tacrolimus capsules, it is recommended to take them immediately if the interval between the next consumption schedule is not too close. If it is close, ignore it and do not double the dose.
Tacrolimus ointment should only be used on the skin, but should not be used on open wounds. Wash your hands before and after using this ointment. Apply a thin layer of ointment evenly on the inflamed area.
Do not shower or swim immediately after using the ointment. If the ointment gets in your eyes, nostrils, or mouth, wash the area immediately with running water.
During treatment, you will be asked to do regular check-ups and undergo blood pressure checks so that the doctor can monitor your condition.
Store tacrolimus capsules or ointment in a closed place in a cool temperature. Protect this medication from direct sunlight and keep it out of reach of children.
Interactions of Tacrolimus with Other Drugs
The use of tacrolimus with certain drugs can cause several drug interactions, such as:
- Increased blood levels of tacrolimus when used with antiviral drugs to treat hepatitis C and HIV infection, macrolide antibiotics, antifungals, ciclosporin, lansoprazole, amiodarone, cimetidine, or metoclopramide
- Increased risk of kidney and nervous system disorders when used with NSAIDs, aminoglycosides, vancomycin, cotrimoxazole, ganciclovir, or acyclovir
- Increased risk of developing hyperkalemia when used with potassium hemal diuretics, eg amiloride, triamterene, or spironolactone
- Decreased blood levels of tacrolimus when used with rifampicin, metamizole, phenytoin, carbamazepine, or isoniazid
- Decreased effectiveness of vaccines containing live attenuated viruses
In addition, there are several interaction effects that can occur if tacrolimus is taken together with certain foods, including:
- Increases blood levels of tacrolimus when taken with grapefruit
- Increases the risk of visual disturbances and neurological disorders if consumed with alcoholic beverages
- Interfere with the absorption of tacrolimus if consumed with high-fat foods
Tacrolimus Side Effects and Dangers
The side effects of using tacrolimus can vary, depending on the form of the drug. For tacrolimus ointment, side effects that can arise are the appearance of stinging, itching, burning, acne, or inflammation of the follicles (folliculitis).
In addition, the use of tacrolimus capsules and injections has the risk of causing side effects such as shaking, headache, nausea, vomiting, stomach pain, or sleep disturbances.
Check with your doctor if the side effects above don't go away or are getting worse. See your doctor immediately if you have an allergic reaction to the drug or a more serious side effect, such as:
- Fever, flu, runny nose, tired, pale skin, cold hands and feet
- Fainting, fast, irregular heartbeat, or chest pain
- Loss of balance, confusion, difficulty concentrating, movement disorders, seizures, or visual disturbances
- Hearing loss, such as ringing in the ears or deafness
- Heart failure which can be characterized by certain symptoms, such as difficulty breathing, swelling in the hands and feet, or unusual tiredness
- Impaired liver function that can be characterized by certain symptoms, such as jaundice, dark urine, severe and persistent nausea and vomiting, or severe abdominal pain
