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