PROGRAF (Tacrolimus)

What is this medication?

Tacrolimus, Advagraf/Astragraf/Envarsus/Prograf
Calcineurin Inhibitor

“ALERT: US Boxed Warning

Malignancies and serious infection:
Increased risk for developing serious infections and malignancies with tacrolimus or other immunosuppressants that may lead to hospitalization or death.

Mortality in liver transplantation (Astagraf XL):
Increased mortality in female transplant patients with Astagraf XL. Astagraf XL is not approved for use in liver transplantation.”

Officially indicated for organ rejection prophylaxis. It is also prescribed off-label for use in Crohn disease (perianal/fistulizing disease), graft-versus host disease (prevention/treatment), immunosuppression (maintenance) after lung transplant, intestinal transplant, myasthenia gravis, rheumatoid arthritis (refractory), and peripheral nerve regeneration.

How does this medication work? 

Tacrolimus suppresses cellular immunity (inhibits T-lymphocyte activation), by binding to an intracellular protein, FKBP-12, and complexes with calcineurin dependent proteins to inhibit calcineurin phosphatase activity. Inhibition of calcineurin also is important in maintaining neuronal and synaptic integrity and homeostasis for peripheral nerve regeneration.  

How should I take this medication?

Immunosuppressants such as tacrolimus have a wide range of dosing options. For a comprehensive listing, please check an official drug monograph. 

What should I watch for while using this medication? 

• Do not use in patients with a known hypersensitivity to tacrolimus.
• Do not use in patients with congenital long QT syndrome
• Use with caution in patient with heart failure, brady arrhythmia, taking antiarrhythmic mediations or other drugs that can lead to QT prolongation
• Immunosuppressant agents including tacrolimus can increase the risk of infection leading to hospitalization or death
• Immunosuppressive agents including tacrolimus may be associated with the development of malignancies that can lead to hospitalization or death

What if I miss a dose?

If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.

How should I store this medication?

Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.

What are the possible side effects of using this medication?

Immunosuppressants such as tacrolimus have an extensive side effect profile. For a comprehensive listing, please check an official drug monograph.