Prograf

What Prograf capsules are used for

Prograf contains tacrolimus, an immunosuppressant — a medicine that calms the immune system. It is given after an organ transplant, usually of a kidney, liver or heart, to stop the body treating the new organ as foreign tissue and attacking it. Tacrolimus works inside T-cells, the white blood cells that start that attack, blocking the signals that switch them on.

Capsules come in 0.5mg, 1mg and 5mg strengths. The lower two strengths are packed in 10s up to 90 capsules; 5mg packs hold 10 or 20.

Tacrolimus also comes as an ointment for eczema, sold as Protopic in 0.03% and 0.1% tubes — the same ingredient rubbed into the skin instead of swallowed after a transplant. More on the ingredient sits on the tacrolimus page.

Taking Prograf: dose timing, food and blood tests

Prograf is a twice-daily capsule, with the two doses about 12 hours apart, for example breakfast time and bedtime. The capsules are swallowed whole with water and never crushed or opened. Meals change how much tacrolimus gets into the blood, and a heavy, fatty one slows absorption, so the safest habit is to take every dose the same way, with food each time or without each time.

Blood tests show how much tacrolimus is circulating, and the dose is set from those results. The gap between a helpful level and a harmful one is narrow, so dose times, meals and test days all carry weight. Keep the capsules in their blister or bottle, out of heat and damp.

Side effects

A fine tremor (shaky hands), headache, diarrhoea, nausea, stomach pain and poor sleep are the common early complaints. Blood pressure and blood sugar often rise, and tacrolimus can harm the kidneys over time. Tingling in the hands or feet and hair thinning are reported as well.

Infections are more likely and can be serious because the immune system is held back; a fever or sore throat is a reason to act quickly rather than wait. Longer term, immunosuppressants carry a higher risk of some cancers, including lymphoma and skin cancer, so a new lump or a mole that changes needs checking.

Foods and medicines that alter tacrolimus levels

Grapefruit and grapefruit juice raise the amount of tacrolimus in the blood, so leave them out. Several medicines do the same: antifungals such as ketoconazole, itraconazole and fluconazole, the antibiotics clarithromycin and erythromycin, and blood pressure medicines such as diltiazem and verapamil. Rifampicin, carbamazepine, phenytoin and St John's wort push the level the other way, low enough for rejection to threaten.

Ciclosporin, another anti-rejection medicine, is not combined with tacrolimus. Live vaccines are avoided while the immune system is suppressed.