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Home > Drug Category > Immunosuppressive Agents > Prograf and Equivalent

Prograf Information

Prograf (Tacrolimus Immediate Release) is primarily used to prevent organ rejection in people who have received a kidney, liver, or heart transplant. Prograf contains the active ingredient tacrolimus, a calcineurin inhibitor (immunosuppressant). It works by binding to a specific protein inside your immune cells. This binding action blocks an enzyme called calcineurin. Under normal circumstances, calcineurin would trigger the production of interleukin-2, a chemical that tells your T-cells (a type of white blood cell) to multiply and attack foreign cells. By shutting down this pathway, Prograf prevents your immune system from recognizing and attacking the new organ.

Your body is designed to identify and destroy any tissue that it doesn't recognize as self, such as a new kidney or liver. Without intervention, the immune system would see the transplanted organ as a massive foreign body and try to kill it, leading to organ failure. Prograf helps by suppressing this specific part of the immune response. It essentially creates a state of immune tolerance, allowing the transplanted organ to function and integrate into your body without being destroyed by your immune system. While it is primarily used in organ transplantation, tacrolimus may also be used to treat various autoimmune or inflammatory conditions, such as refractory ulcerative colitis, myasthenia gravis, lupus nephritis, and autoimmune hepatitis.

Prograf Side Effects

Common mild side effects of this medication include tremors, headache, diarrhea, mild nausea and vomiting, stomach discomfort, loss of appetite, trouble sleeping, and numbness or tingling of the hands and feet. Contact your doctor if these mild side effects persist or worsen.

Contact your doctor immediately if you experience any serious side effects, including the following:
• Allergic reactions such as breathing difficulties, body itching, body rash, skin blistering, swelling of the face, mouth, tongue, lips, or throat;
• Anemia (low red blood cells) with symptoms like dizziness, pale skin, unusual tiredness or weakness, shortness of breath;
• Electrolyte imbalances like high levels of potassium in your blood with symptoms such as muscle weakness, irregular heartbeat;
• Heart problems (QT prolongation) such as chest pain, dizziness, fainting, low or no pulse, nausea, pain spreading from the shoulder;
• High blood pressure;
• High blood sugar with symptoms like frequent urination, confusion, fruity smell on your breath, and increased thirst or hunger;
• Kidney problems;
• Nervous system problems such as confusion, numbness and tingling, vision changes, and tremors

Inform your doctor about any other side effects you notice that are not listed here.

Prograf Precautions

Do not use this medicine if you are allergic to tacrolimus or any other ingredients in Prograf. Before using this medication, ensure you inform your doctor about any medical conditions you previously or currently have, including the following:
• Cancer;
• Current infections;
• Diabetes;
• Electrolyte imbalances such as high levels of potassium;
• Gastrointestinal problems like peptic ulcers;
• Heart disease;
• High blood pressure;
• Kidney disease;
• Liver disease;
• Reversible posterior leukoencephalopathy syndrome (RPLS)

Since your immune system is suppressed, live vaccines, such as the MMR and yellow fever, could actually cause the disease they are meant to prevent. Therefore, avoid live vaccines while taking this medication. This medication is not recommended for use during pregnancy unless the benefit to the mother outweighs the risk to the fetus. Women of reproductive age and men who have female partners of reproductive age should use effective birth control methods while taking this medication. Consult your doctor before using this medication while breastfeeding, as it can pass through breast milk. Limit your skin's exposure to sunlight and wear sunscreen and protective clothing when outdoors, as this medication can make your skin more sensitive to sunlight.

Medications like clarithromycin, erythromycin, ketoconazole, itraconazole, and certain HIV medications (e.g, ritonavir) can cause tacrolimus levels to spike dangerously. Therefore, make sure you inform your doctor about all the medications, including herbal medications and supplements, you are taking before starting Prograf to prevent drug interactions. Prograf is available as an immediate-release capsule that should be taken orally with or without food as directed by your doctor. Since this is the immediate-release formulation, it is typically taken twice daily, approximately 12 hours apart. Your doctor will determine the best dose for you depending on your medical condition and response to treatment. It is important to use this medication regularly as directed by your doctor for optimal effect.

Doctors perform regular blood tests to measure the "trough level" (the lowest level of the drug in the bloodstream) to adjust the dose. While taking it on an empty stomach (1 hour before or 2 hours after a meal) often yields the best absorption, staying consistent with your routine is the priority to avoid fluctuating blood levels. Avoid grapefruit or grapefruit juice, pomelos, and Seville oranges while taking this medication, as grapefruit can inhibit the enzymes that break down tacrolimus, potentially leading to toxic blood levels of the medication. Refer to the leaflet in the medication pack for more usage instructions. Store this medication in a cool, dry place, protect it from light and moisture, and keep it out of reach of children.

Do I need a prescription to order Prograf?

Yes, a prescription is required from your physician to order Prograf.