Tacrolimus (Intravenous route)

Pronunciation:

ta-KROE-li-mus

Brand Names:

Prograf

Dosage Forms:

Solution

Warnings:

Intravenous route(Solution)

Increased risk for developing serious infections and malignancies with tacrolimus for IV injection or other immunosuppressants that may lead to hospitalization or death ..

Classifications:

Therapeutic—

Immune Suppressant

Pharmacologic—

Calcineurin Inhibitor

Uses of This Medicine:

Tacrolimus injection is used together with other medicines to prevent the body from rejecting a transplanted organ (eg, kidney, liver, heart, or lung). This medicine may be used with steroids, azathioprine, or mycophenolate mofetil. Tacrolimus belongs to a group of medicines known as immunosuppressive agents.

When a patient receives an organ transplant, the body's white blood cells will try to get rid of (reject) the transplanted organ. Tacrolimus works by suppressing the immune system to prevent the white blood cells from trying to get rid of the transplanted organ.

Tacrolimus is a very strong medicine. It can cause side effects that can be very serious, such as kidney problems. It may also decrease the body's ability to fight infections. You and your doctor should talk about the benefits of this medicine as well as the risks of using it.

This medicine is to be given only by or under the direct supervision of a doctor.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of tacrolimus injection in children with liver, kidney, heart, or lung transplants.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of tacrolimus injection in the elderly. However, elderly patients are more likely to have kidney, liver, or heart problems, which may require caution and an adjustment in the dose for patients receiving tacrolimus injection.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Bepridil
Cisapride
Dronedarone
Fluconazole
Lefamulin
Mesoridazine
Mifepristone
Nelfinavir
Pimozide
Piperaquine
Posaconazole
Ritonavir
Saquinavir
Sparfloxacin
Terfenadine
Thioridazine
Ziprasidone

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Abacavir
Abametapir
Aceclofenac
Acemetacin
Adagrasib
Adenovirus Vaccine, Live
Alefacept
Alfuzosin
Amikacin
Amiloride
Amiodarone
Amisulpride
Amitriptyline
Amlodipine
Amphotericin B
Amprenavir
Amtolmetin Guacil
Anagrelide
Apalutamide
Apomorphine
Aprepitant
Aripiprazole
Aripiprazole Lauroxil
Armodafinil
Arsenic Trioxide
Asciminib
Asenapine
Aspirin
Astemizole
Atazanavir
Avacopan
Azilsartan
Azilsartan Medoxomil
Azithromycin
Bacillus of Calmette and Guerin Vaccine, Live
Bedaquiline
Belzutifan
Benazepril
Berotralstat
Boceprevir
Bosentan
Bromfenac
Bufexamac
Buprenorphine
Buserelin
Candesartan
Cannabidiol
Cannabis
Canrenoate
Canrenone
Capreomycin
Captopril
Carbamazepine
Caspofungin
Celecoxib
Cenobamate
Ceritinib
Chloramphenicol
Chloroquine
Chlorpromazine
Cholera Vaccine, Live
Choline Salicylate
Cimetidine
Ciprofloxacin
Cisplatin
Citalopram
Clarithromycin
Clofazimine
Clomipramine
Clonixin
Clothiapine
Clotrimazole
Clozapine
Cobicistat
Colchicine
Conivaptan
Crizotinib
Cyclobenzaprine
Cyclosporine
Dabrafenib
Dalfopristin
Darunavir
Dasabuvir
Dasatinib
Degarelix
Delamanid
Delavirdine
Dengue Tetravalent Vaccine, Live
Desipramine
Deslorelin
Deutetrabenazine
Dexamethasone
Dexibuprofen
Dexketoprofen
Dexmedetomidine
Diclofenac
Didanosine
Diflunisal
Diltiazem
Dipyrone
Disopyramide
Dofetilide
Dolasetron
Domperidone
Donepezil
Doxepin
Droperidol
Droxicam
Ebastine
Ebola Zaire Vaccine, Live
Echinacea
Efavirenz
Elacestrant
Elagolix
Elbasvir
Eliglustat
Eluxadoline
Emtricitabine
Enalapril
Enalaprilat
Encorafenib
Entrectinib
Enzalutamide
Eplerenone
Eprosartan
Erdafitinib
Eribulin
Erythromycin
Escitalopram
Eslicarbazepine Acetate
Esomeprazole
Etodolac
Etofenamate
Etoricoxib
Etravirine
Famotidine
Fedratinib
Felbamate
Felbinac
Felodipine
Fenoprofen
Fentanyl
Fepradinol
Feprazone
Fexinidazole
Fingolimod
Flecainide
Floctafenine
Flufenamic Acid
Fluoxetine
Flurbiprofen
Fluvoxamine
Formoterol
Fosamprenavir
Fosaprepitant
Foscarnet
Fosinopril
Fosnetupitant
Fosphenytoin
Fostemsavir
Galantamine
Gatifloxacin
Gemifloxacin
Gentamicin
Gepirone
Glasdegib
Glecaprevir
Gonadorelin
Goserelin
Granisetron
Grazoprevir
Halofantrine
Haloperidol
Histrelin
Hydroquinidine
Hydroxychloroquine
Hydroxyzine
Ibuprofen
Ibuprofen Lysine
Ibutilide
Idelalisib
Iloperidone
Imatinib
Imipramine
Indinavir
Indomethacin
Infliximab
Influenza Virus Vaccine, Live
Inotuzumab Ozogamicin
Irbesartan
Isavuconazonium Sulfate
Itraconazole
Ivabradine
Ivacaftor
Ivosidenib
Kanamycin
Ketoconazole
Ketoprofen
Ketorolac
Lamivudine
Lanreotide
Lapatinib
Larotrectinib
Lasmiditan
Lenacapavir
Lenvatinib
Letermovir
Leuprolide
Levamlodipine
Levofloxacin
Lisinopril
Lofexidine
Lomitapide
Lopinavir
Lorlatinib
Lornoxicam
Losartan
Loxoprofen
Lumacaftor
Lumefantrine
Lumiracoxib
Macimorelin
Mavacamten
Measles Virus Vaccine, Live
Meclofenamate
Mefenamic Acid
Mefloquine
Meloxicam
Methadone
Methotrimeprazine
Methylprednisolone
Metoclopramide
Metronidazole
Mibefradil
Mirtazapine
Mitotane
Mizolastine
Mobocertinib
Modafinil
Moexipril
Moricizine
Morniflumate
Moxifloxacin
Mumps Virus Vaccine, Live
Mycophenolic Acid
Nabumetone
Nafarelin
Nafcillin
Naproxen
Nefazodone
Neomycin
Nepafenac
Netilmicin
Netupitant
Nevirapine
Nicardipine
Nifedipine
Niflumic Acid
Nilotinib
Nimesulide
Nimesulide Beta Cyclodextrin
Nirmatrelvir
Norfloxacin
Octreotide
Ofloxacin
Olanzapine
Olmesartan
Omaveloxolone
Ombitasvir
Omeprazole
Ondansetron
Osilodrostat
Osimertinib
Oxaliplatin
Oxaprozin
Oxcarbazepine
Oxyphenbutazone
Ozanimod
Pacritinib
Palbociclib
Paliperidone
Panobinostat
Papaverine
Parecoxib
Paritaprevir
Paromomycin
Paroxetine
Pasireotide
Pazopanib
Pentamidine
Perindopril
Perphenazine
Phenobarbital
Phenylbutazone
Phenytoin
Piketoprofen
Pimavanserin
Pipamperone
Piroxicam
Pirtobrutinib
Pitolisant
Pixantrone
Plazomicin
Poliovirus Vaccine, Live
Ponesimod
Potassium Phosphate
Prednisone
Primidone
Probucol
Procainamide
Prochlorperazine
Proglumetacin
Promethazine
Propafenone
Propionic Acid
Propyphenazone
Proquazone
Protriptyline
Quetiapine
Quinapril
Quinidine
Quinine
Quinupristin
Quizartinib
Ramipril
Ranitidine
Ranolazine
Relugolix
Remdesivir
Ribociclib
Rifabutin
Rifampin
Rifapentine
Risperidone
Ritlecitinib
Rofecoxib
Rotavirus Vaccine, Live
Rubella Virus Vaccine, Live
Salicylic Acid
Salsalate
Schisandra sphenanthera
Selpercatinib
Sertindole
Sertraline
Sevoflurane
Simeprevir
Siponimod
Sirolimus
Smallpox Monkeypox Vaccine, Live Non-Replicating
Smallpox Vaccine
Sodium Phosphate
Sodium Phosphate, Dibasic
Sodium Phosphate, Monobasic
Sodium Salicylate
Solifenacin
Sorafenib
Sotalol
Sotorasib
Sparsentan
Spectinomycin
Spirapril
Spironolactone
Stavudine
St John's Wort
Streptomycin
Sulindac
Sulpiride
Sultopride
Sunitinib
Tamoxifen
Taurursodiol
Telaprevir
Telavancin
Telithromycin
Telmisartan
Tenofovir
Tenoxicam
Tepotinib
Tetrabenazine
Tiaprofenic Acid
Tipranavir
Tizanidine
Tobramycin
Tocilizumab
Tofacitinib
Tolfenamic Acid
Tolmetin
Tolterodine
Toremifene
Trandolapril
Trazodone
Triamterene
Triclabendazole
Trimipramine
Triptorelin
Trofinetide
Tucatinib
Typhoid Vaccine, Live
Valdecoxib
Valsartan
Vandetanib
Vardenafil
Varicella Virus Vaccine, Live
Vemurafenib
Venlafaxine
Verapamil
Vilanterol
Vilazodone
Vinflunine
Voclosporin
Vonoprazan
Voriconazole
Vorinostat
Voxelotor
Voxilaprevir
Yellow Fever Vaccine
Zidovudine
Zoster Vaccine, Live
Zotepine
Zuclopenthixol

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Danazol
Ertapenem
Lansoprazole
Tigecycline

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

Grapefruit Juice

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

Allergy to polyoxyl 60 hydrogenated castor oil—Should not be used in patients with this condition.

Cystic fibrosis—May require a higher dose for patients with this condition.

Diabetes or
Heart disease or
Heart rhythm problems (eg, QT prolongation), or history of or
Hyperkalemia (high potassium in the blood) or
Hypertension (high blood pressure) or
Myocardial hypertrophy (heart is larger than normal), history of or
Paresthesia (numbness or tingling in the hands, arms, legs, or feet), history of or
Seizures (convulsions), history of or
Tremors—Use with caution. May make these conditions worse.

Infection, active (eg, bacteria, fungus, or virus)—May decrease your body's ability to fight an infection.

Kidney disease or
Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of This Medicine:

A nurse or other trained health professional will give you this medicine in a hospital. It is given through a needle placed into one of your veins. The medicine must be injected slowly, so your IV tube will need to stay in place for 30 minutes.

You will only receive this medicine for a few days. Then your doctor will switch you to the oral (by mouth) form of tacrolimus.

This medicine comes with a patient information insert and patient instructions. Read and follow the instructions carefully. Ask your doctor if you have any questions.

You should not eat grapefruit or drink grapefruit juice while you are receiving this medicine. Grapefruit and grapefruit juice will increase the amount of medicine in the body.

Precautions While Using This Medicine:

It is very important that your doctor check your progress while you are receiving this medicine to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Receiving this medicine while you are pregnant can harm your unborn baby. It may also cause birth defects if the father is using it when his sexual partner becomes pregnant. If you think you have become pregnant while receiving this medicine, tell your doctor right away.

You should not receive this medicine together with sirolimus (Rapamune®).

Tacrolimus injection may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Call your doctor or nurse right away if you have itching, hives, hoarseness, trouble breathing or swallowing, or any swelling of your hands, face, or mouth after you receive this medicine.

This medicine may increase your risk of getting skin cancer or cancer of the lymph system (lymphoma). Talk to your doctor if you have concerns about this risk.

This medicine may increase your risk of developing infections. Avoid being near people who are sick while you are receiving this medicine. Wash your hands often. Tell your doctor if you have any kind of infection before you start receiving this medicine. Tell your doctor if you have ever had an infection that would not go away or an infection that kept coming back.

While you are being treated with tacrolimus, and after you stop treatment with it, do not have any immunizations (vaccines) without your doctor's approval. Tacrolimus may lower your body's resistance and the vaccine may not work as well or you might get the infection the vaccine is meant to prevent. In addition, you should not be around other persons living in your household who receive live virus vaccines because there is a chance they could pass the virus on to you. Some examples of live vaccines include measles, mumps, influenza (nasal flu vaccine), poliovirus (oral form), rotavirus, and rubella. Do not get close to them and do not stay in the same room with them for very long. If you have questions about this, talk to your doctor.

This medicine may increase your risk for developing a rare and serious virus infection with the BK polyoma virus. This virus may affect how your kidneys work and cause a transplanted kidney to fail. Check with your doctor right away if you have bloody urine, 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, or weight gain.

Tell your doctor if you have African or Hispanic relatives. You may be at an increased risk for diabetes after transplant. If you are African-American, you might need a higher dose of this medicine. Talk to your doctor if you have concerns.

This medicine may increase your risk of developing a serious and rare brain infection called progressive multifocal leukoencephalopathy (PML). Check with your doctor right away if you have vision changes, loss of coordination, clumsiness, confusion, memory loss, difficulty speaking or understanding what others say, and weakness in the legs.

This medicine may cause serious brain or nerve problems (eg, posterior reversible encephalopathy syndrome). Tell your doctor right away if you have blurred vision, confusion, dizziness, headache, mental changes, seizures, high blood pressure, unusual drowsiness, tiredness, or weakness, or a fast heartbeat.

Hyperkalemia (high potassium in the blood) may occur while you are receiving this medicine. Check with your doctor right away if you have confusion, difficulty with breathing, irregular heartbeat, nausea or vomiting, nervousness, numbness or tingling in the hands, feet, or lips, stomach pain, or weakness or heaviness of the legs.

Tacrolimus may cause a condition called pure red cell aplasia (PRCA). This is a very rare condition where the body no longer makes red blood cells and the patient has severe anemia. Check with your doctor right away if you have a fever and sore throat, pale skin, unusual bleeding or bruising, or unusual tiredness or weakness.

Use sunscreen or sunblock lotion with a sun protection factor (SPF) of at least 15 on a regular basis when you are outdoors. Wear protective clothing and hats, and stay out of direct sunlight between the hours of 10 am and 3 pm. Avoid sunlamps and tanning beds.

If you plan to have children, talk with your doctor before using this medicine. Some men and women using this medicine have become infertile (unable to have children).

This medicine may cause thrombotic microangiopathy (damage in the smallest blood vessels), hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura. Tell your doctor right away if you have a change in mental status, dark or bloody urine, decreased urine output, difficulty speaking, fever, pale color of the skin, pinpoint red spots on the skin, seizures, severe chest pain, sudden weakness in the arms or legs, unusual bleeding or bruising, or yellow eyes or skin.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, cannabidiol, St. John's wort) or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common: Abnormal dreams; agitation; anxiety; blurred vision; chills; confusion; cough; diarrhea; dizziness; dry mouth; fever; flushed, dry skin; frequent urination; fruit-like breath odor; general feeling of discomfort or illness; headache; increased hunger; increased thirst; increased urination; itching, skin rash; joint pain; loss of appetite; loss of consciousness; loss of energy or weakness; mental depression; muscle aches and pains; muscle trembling or twitching; nausea; nervousness; pale skin; runny nose; seeing or hearing things that are not there; seizures; shivering; sore throat; stomach pain; sweating; swelling of the feet or lower legs; tingling; trembling and shaking of the hands; trouble breathing; trouble with sleeping; unexplained weight loss; unusual bleeding or bruising; unusual tiredness or weakness; vomiting

Less common: Chest pain; increased sensitivity to pain; muscle cramps; numbness or pain in the legs; ringing in the ears

Rare: Enlarged heart; flushing of the face or neck; weight loss

Incidence not known: Black, tarry stools; blistering, peeling, or loosening of the skin; bloated stomach; bloating; bloody nose; bloody urine; blurred vision; change in mental status; constipation; drowsiness; fainting; fast, slow, or irregular heartbeat; heartburn; heavier menstrual periods; increased blood pressure; indigestion; joint pain; lightheadedness; lower back or side pain; pain and fullness in the right upper stomach; pinpoint red spots on the skin; pounding or rapid pulse; red, irritated eyes; red skin lesions, often with a purple center; skin sores; ulcers or white spots in mouth or on lips; weakness; weight gain; yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common: Belching; difficulty with moving; muscle stiffness

Less common: Body aches or pain; burning or stinging of the skin; cracks in the skin; crying; delusions of persecution, mistrust, suspiciousness, or combativeness; dysphoria; excessive muscle tone; false beliefs that cannot be changed by facts; false or unusual sense of well-being; feeling of constant movement of self or surroundings; feeling of unreality; feeling that others are watching you or controlling your behavior; feeling that others can hear your thoughts; increased sensitivity of the skin to sunlight; large, flat, blue or purplish patches in the skin; muscle tension or tightness; painful blisters on the trunk of the body; painful cold sores or blisters on the lips, nose, eyes, or genitals; poor insight and judgment; problems with memory or speech; quick to react or overreact emotionally; rapidly changing moods; redness or other discoloration of the skin; restlessness; scaly skin; sensation of spinning; sense of detachment from self or body; severe mood or mental changes; severe sunburn; sleepiness or unusual drowsiness; sore mouth or tongue; sores on the skin; swelling or inflammation of the mouth; tender, swollen glands in the neck; trouble recognizing objects; trouble thinking and planning; trouble walking; unusual behavior; white patches in the mouth, tongue, or throat

Incidence not known: Change in color vision; decreased weight; difficulty seeing at night; feeling hot and cold; hearing loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Last Updated: 11/16/2023

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