Tacrolimus
Type of Medication: Immunosuppressant
Indications: Immunosuppression post transplant
Side Effects: Gastro-intestinal disturbances including dyspepsia, and inflammatory and ulcerative disorders, hypertension, angina, tachycardia, tremor, headache, insomnia, anxiety, depression, convulsions, photophobia, tinnitus, deafness, heamatologic disorders including:leucopenia/cytosis, haemolytic aplastic anaemia, renal failure, hypercalcaemia, hyperkalaemia,hypophosphataemia, pruritus,constipation, hepatic dysfunction, cholestatic jaundice, hyperglycaemia, cramps, dyspnoea, alopecia, acne, pruritus, sweating, photosensitivity, renal tubular acidosis, encephalopathy, tachycardia, cardiomyopathy, ECG changes.
Route of administration: Adult (Oral)
Dose:Dose adjusted by transplant unit based on serum levels. Usually within range of 1-4mg bd. Always discuss with transplant unit
Administration:
Route of administration: Paediatric (Oral)
Dose:dose adjusted by transplant unit based on serum levels. Usually within range of 1-4mg bd. Always discuss with transplant unit.
Administration: CSM Warning; Cardiomyopathy has been reported in children given tacrolimus after a transplant. Patients should be monitered closely.
Examples of some Drug Interactions
Interacting drug: Aminoglycosides
increased risk of nephrotoxicity
Interacting drug: Amphotericin
increased risk of nephrotoxicity
Interacting drug: Calcium channel blockers
Increase plasma concentration of tacrolimus
Interacting drug: Caspofungin
Decreases tacrolimus plasma concentration
Interacting drug: Chloramphenicol
increases tacrolimus concentration
Interacting drug: Clarithromycin, Erythromycin
increases tacrolimus concentration
Interacting drug: Cyclosporin
increased cyclosporin half life resulting in increased risk of toxicity
Interacting drug: Fluconazole (and other imidazoles)
increase tacrolimus level
Interacting drug: NSAID including Ibuprofen
increased risk of nephrotoxicity
Interacting drug: Omeprazole
increases tacrolimus level
Interacting drug: Oral contraceptive
reduces efficacy of pill
Interacting drug: Potassium sparing diuretics
Increased risk of hyperkaleamia
Interacting drug: Rifampicin
decreases tacrolimus concentration
Interacting drug: St Johns Wort
Decreases tacrolimus level, avoid concomitant use