Prograf

1 What is Prograf?

Brand: Prograf

Generic: Tacrolimus

Prograf is an immunosuppressive agent that is used to suppress the immune system of a patient who has received an organ from a donor. Using Prograf weakens your immune system thus making you more susceptible to infections.

Therefore, the risks and benefits of the use should be considered before taking tacrolimus. Only a doctor or a health personnel in the presence of a doctor can inject this drug. It is available as:

  • Solution

2 What to Know Before Using

Before using Prograf, you must know all about the risks and complications associated with it. Together with your doctor, you can decide whether the medication will provide you more goods than the harms.

Here are some factors to be considered before deciding to use this medicine:

  • Allergies: Inform your doctor about the allergies you have, such as to this medication, other medications, or to foods, dyes, or preservatives.
  • Pediatric: Not enough pediatric studies have been carried out. So, safety and efficacy of tacrolimus in children are not clear.
  • Geriatric: Tacrolimus may be used cautiously in elderly after adjusting doses.
  • Pregnancy: Tacrolimus falls under category C for all trimesters, meaning that due to lack of sufficient studies, it’s not clear if this medication is safe for use in pregnancy.
  • Breastfeeding: Tacrolimus may be used cautiously in a nursing mother after assessing both risks and benefits of the use.
  • Drug Interactions: Taking two medicines together can be harmful due to possible interactions. In other cases, even if there is a possible interaction between two medicines your doctor may advise you to take them together after adjusting the dose or issuing precautions. Here is a list of the medicines which in general are not recommended to be used with this medicine. Inform your doctor if you are using any of these medicines:

        o Amifampridine
        o Bepridil
        o Cisapride
        o Dronedarone
        o Mesoridazine
        o Mifepristone
        o Nelfinavir
        o Pimozide
        o Posaconazole
        o Saquinavir
        o Sparfloxacin
        o Terfenadine

Though usually not recommended, your doctor may decide, after adjusting dose or frequency of one or both medicines, to use tacrolimus injection with any of the following medicines:

        o Aceclofenac
        o Amiodarone
        o Amitriptyline
        o Amlodipine
        o Amprenavir
        o Apomorphine
        o Aprepitant
        o Aripiprazole
        o Asenapine
        o Aspirin
        o Astemizole
        o Atazanavir
        o Azithromycin
        o Live BCG vaccine
        o Boceprevir
        o Bromfenac
        o Carbamazepine
        o Caspofungin
        o Celecoxib
        o Ceritinib
        o Chloroquine
        o Chlorpromazine
        o Ciprofloxacin
        o Citalopram
        o Clarithromycin
        o Clomipramine
        o Clozapine
        o Colchicine
        o Cyclobenzaprine
        o Cyclosporine
        o Delavirdine
        o Desipramine
        o Dexamethasone
        o Dexibuprofen
        o Dexketoprofen
        o Diclofenac
        o Diltiazem
        o Disopyramide
        o Dofetilide
        o Domperidone
        o Donepezil
        o Doxepin
        o Droperidol
        o Erythromycin
        o Escitalopram
        o Esomeprazole
        o Etodolac
        o Etoricoxib
        o Famotidine
        o Fenoprofen
        o Flecainide
        o Floctafenine
        o Flufenamic Acid
        o Fluoxetine
        o Flurbiprofen
        o Formoterol
        o Fosamprenavir
        o Gatifloxacin
        o Golimumab
        o Granisetron
        o Halofantrine
        o Haloperidol
        o Hydroxychloroquine
        o Ibuprofen
        o Imipramine
        o Indinavir
        o Indomethacin
        o Infliximab
        o Itraconazole
        o Ketoconazole
        o Ketoprofen
        o Ketorolac
        o Loxoprofen
        o Live Measles Virus Vaccine
        o Mefenamic Acid
        o Mefloquine
        o Meloxicam
        o Metronidazole
        o Live Mumps Virus Vaccine
        o Nafarelin
        o Naproxen
        o Norfloxacin
        o Octreotide
        o Ofloxacin
        o Olanzapine
        o Omeprazole
        o Ondansetron
        o Paroxetine
        o Pasireotide
        o Phenobarbital
        o Phenytoin
        o Piroxicam
        o Live Poliovirus Vaccine
        o Prednisone
        o Procainamide
        o Prochlorperazine
        o Promethazine
        o Propafenone
        o Quinidine
        o Quinine
        o Ranolazine
        o Rifampin
        o Risperidone
        o Live Rotavirus Vaccine
        o Live Rubella Virus Vaccine
        o Salsalate
        o Smallpox Vaccine
        o Sorafenib
        o Sotalol
        o St John's Wort
        o Sulindac
        o Tamoxifen
        o Telithromycin
        o Tizanidine
        o Tocophersolan
        o Trazodone
        o Typhoid Vaccine
        o Valdecoxib
        o Varicella Virus Vaccine
        o Venlafaxine
        o Verapamil
        o Voriconazole
        o Yellow Fever Vaccine

Though usually not recommended, your doctor may decide, after adjusting dose or frequency of one or both medicines, to use tacrolimus injection with any of the following medicines:

        o Chloramphenicol
        o Clotrimazole
        o Danazol
        o Ertapenem
        o Lansoprazole
        o Metoclopramide
        o Nifedipine

  • Other Interactions: DO NOT drink while you are being treated with tacrolimus.
  • Medical Problems: DO NOT forget to inform your doctor about the following conditions:

        o Allergy to polyoxyl 60 hydrogenated castor oil (Don’t use tacrolimus)
        o Diabetes
        o Hyperkalemia
        o Hypertension
        o History of Myocardial hypertrophy (enlarged heart)
        o Paresthesias (numbness or tingling sensations)
        o History of convulsions
        o Shaking (Use cautiously)
        o Active bacterial, fungal or viral infection
        o Kidney or Liver problems (Use cautiously)

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3 Proper Usage

To use Prograf properly, you must follow all instructions given by your doctor. Here are some points to watch for:

  • This medicine is injected into your vein by a nurse. After a few days, your doctor will replace the injections with oral medicine.
  • Read the patient information leaflet carefully and talk to your doctor if you have any query.

4 Precautions to Take

Before using Prograf, there are some precautions you must take. Your progress should be regularly monitored to determine if you are responding to the treatment. Your doctor may order blood and urine tests to look for unwanted effects. Remember:

Tacrolimus injection may cause life-threatening allergic conditions like anaphylaxis. Seek immediate help if you experience following symptoms after getting tacrolimus injections: 

  • Itching, welts
  • Hoarseness
  • Breathing or swallowing problems
  • Swollen hands, face, or mouth 

Ask your doctor about increased risk of skin or immune cell cancer (lymphoma).

You may also become more prone to infections. Therefore to reduce your risk:

  • Stay away from ill people or those who have received vaccines against measles, influenza, rubella, mumps, and other live vaccines. 
  • Maintain proper hygiene.
  • Inform your doctor about any illness you had before starting tacrolimus or any other chronic illness.
  • Consult your doctor before getting vaccinated during treatment with tacrolimus.

Tacrolimus can also make you more susceptible to a rare and serious viral infection caused by BK virus which can lead to failure of the transplanted kidney. Check with your doctor right away if you are having more than one of these symptoms:

  • Bloody urine
  • A decreased frequency or amount of urine
  • Increased thirst
  • Loss of appetite
  • Lower back or side pain
  • Nausea
  • Swelling of the face, fingers, or lower legs
  • Trouble with breathing
  • Unusual tiredness or weakness
  • Vomiting
  • Weight gain

If you develop two or more of the following symptoms, see your doctor immediately as they might indicate progressive multifocal leukoencephalopathy (PML), a serious and rare brain infection. 

  • Vision problems
  • Coordination, memory or speech problems
  • Confusion
  • Leg weakness

If you develop following symptoms, see your doctor immediately as they might indicate some serious problems related to nervous system. 

If you develop following symptoms, see your doctor immediately as they might indicate hyperkalemia (high blood potassium level),

  • Stomach pain
  • Confusion
  • Breathing difficulty 
  • Abnormal heartbeat
  • Nervousness 
  • Numb hands, feet, or lips
  • Breathing difficulties 
  • Weakness or heaviness of the legs. 

A very rare condition called pure red cell aplasia (PRCA) may develop in some patients taking tacrolimus. See your doctor immediately if you have:

  • Fever and sore throat
  • Pale skin
  • Abnormal bleeding or bruising
  • Excessive tiredness 

5 Potential Side Effects

Make sure you meet with your doctor in using Prograf to avoid unwanted potential side effects.

Consult your doctor immediately if you experience any of the following side effects:

More common:

  • Abdominal pain
  • Abnormal dreams
  • Restlessness
  • Anxiety
  • Confusion
  • Convulsions
  • Dizziness
  • Flu-like symptoms
  • Increased urinary frequency
  • Depression
  • Muscle twitching
  • Nervousness
  • Pale skin
  • Hallucinations
  • Breathing problems
  • Skin rash
  • Swollen feet or lower legs
  • Abnormal shaking hands
  • Sleep problems
  • Abnormal bleeding or bruising

Less common:

Rare: 

Mild and non-serious side effects usually go away on their own without requiring medical intervention. You may also ask your doctor to learn more about how you may prevent or reduce the side effects.

Talk to your doctor if the side effects persist or worry you, including:

More common:

  • Excessive stomach acid
  • Burp
  • Muscle weakness muscle
  • Sleep problems

Less common

  • Body aches
  • burning sensation in the skin
  • Delusions
  • Dementia
  • Depersonalization
  • Dysphoria
  • Euphoria
  • Paranoia
  • Restlessness
  • Sunburn
  • Drowsiness
  • Sore mouth or tongue
  • Tender, swollen neck glands
  • White patches in the mouth, tongue, or throat

The side effects of the medicine are not limited to the ones listed above. Call your doctor immediately if you experience any side effects that are uncommon or worry you. To report side effects to the FDA, contact at 1-800-FDA-1088.

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