Tacrolimus is part of a group of medicines called immunosuppressants. They work by reducing the inflammatory action of your disease. For it to work well, this medicine should be taken regularly. Do not be discouraged if results are not immediate; it usually takes one to three weeks for your condition to improve.
Please note that tacrolimus does not help everyone who takes it.
How do I take tacrolimus?
Tacrolimus is usually taken daily, in two doses. It should be taken on an empty stomach, either one hour before or two to three hours after meals. Avoid grapefruit juice while taking the drug as this interferes with tacrolimus.
Tacrolimus is available in three different capsule strengths – 500 micrograms,1 milligram and 5 milligrams. The dose prescribed will depend upon your weight and how severe your disease is.
Please ensure you always take the same brand of tacrolimus capsules unless it is a change agreed with and recommended by the doctor who looks after your condition.
Can I carry on taking my other medications?
Due to the potential risk of the drug interacting with other medicines, you should inform your doctor and/or pharmacist about any medication you are currently taking, or any new medicines you have been prescribed. To ensure you remember everything, it may be helpful to bring a list of current medications with you when you see the doctor, nurse or pharmacist. This includes any medications bought from the pharmacy without a prescription as well as herbal and complementary medicines (e.g. St. John’s Wort).
You should also inform us if you are allergic to any medications particularly drugs called macrolides (e.g. erythromycin or clarithromycin antibiotics).
Previous medical issues
Before starting tacrolimus, you should tell the doctor, nurse or pharmacist if you have high blood pressure, impaired kidney or liver function. You must also inform us if you have a weak immune system or a tendency to catch infections easily. We also need to know if you have any neurological or heart problems, or currently have a serious infection.
Alcohol intake
You are advised not to drink more than 14 units of alcohol per week, spread evenly over three or more days, on a regular basis. 14 units is equivalent to six pints of average-strength beer or 10 small glasses of low-strength wine.
Pregnancy, contraception and breastfeeding
Due to a potential risk to the foetus, you should use non-hormonal barrier contraception methods (such as condoms), while on tacrolimus and for three months after stopping the drug. Please inform your doctor as soon as possible if you plan to become pregnant or think that you may be pregnant. If you are breast-feeding, please inform your doctor before starting treatment.
Viral infections and vaccinations
Your body’s resistance to infection can be reduced while you are taking tacrolimus.
Therefore you should avoid close contact with people who have viral infections- in particular chicken pox or shingles. If you develop either of these, you should inform your doctor immediately. You should also ask your doctor or pharmacist before having any vaccinations.
You may also be more at risk of catching infections of the skin, mouth, stomach and intestines, lungs and urinary tract. Please inform your doctor about any symptoms of infection which last for more than three days (for example, sore throat, cough, fever).
Food preparation
There are some reports of bacteria (germs) found in food that may cause a problem to those who are less able to fight infections. Your body’s resistance to infection can be reduced while you are taking tacrolimus. Cooked chilled foods should be reheated thoroughly, and salads washed well; avoid ready-prepared supermarket salads. Do not eat soft cheese made from unpasteurised milk.
Driving
Tacrolimus may affect your performance of skilled tasks (e.g. driving) so please avoid this if you find yourself affected.
Sun exposure
Take care to avoid too much sun (including sun beds) whilst taking this medicine and use a sunscreen with a high protection factor e.g. SPF 50.
Which tests will I need and how often will I need them?
It is very important that you are regularly checked whilst using tacrolimus.
A blood test is usually needed every two weeks for six weeks, then monthly thereafter. This may vary depending on your condition. Your weight, blood pressure, cholesterol and blood sugar will also be checked regularly. It is your responsibility to ensure that you have your blood tests on time. It is important that you do not miss these and that you do not take tacrolimus unless you are having blood tests regularly.
The levels of tacrolimus in your body will need to be checked every month until you are stable on the medication and 2 weeks after dose changes. You should take your evening dose at 10pm and arrange to have a blood test at 10am the following day, before your morning dose
As with most medicines, tacrolimus may cause side-effects, although most people do not develop serious side effects.
Possible side-effects include blood disorders (e.g. anaemia, increased potassium in the blood, difficulty sleeping, trembling, headache, increased blood pressure, diarrhoea, nausea, constipation, dyspepsia and skin disorders). There is also a slight increased risk of certain types of cancer in people taking tacrolimus.
Tacrolimus may also cause increased blood sugar (diabetes). Therefore, you should contact your doctor in the case of frequent urination, increased thirst/hunger or if you are feeling generally unwell. Rarely, tacrolimus can affect your heart or kidney function. If you experience shortness of breath, a persistent cough or foot/ankle swelling, contact your doctor immediately.
Please refer to the leaflet included with the medicine for further information, or contact the pharmacy department on: 020 7566 2362.
Approval date: March 2024
Review date: March 2026