Tacrolimus brands and prices in Pakistan

About Tacrolimus

Tacrolimus is a medicine that calms down (suppresses) the body's immune system. It comes in two main kinds. Capsules, liquid granules and long-acting capsules or tablets are taken by mouth, mostly after an organ transplant so the body does not attack and reject the new organ. Tacrolimus ointment is rubbed onto the skin to treat eczema; it belongs to a group called topical calcineurin inhibitors and is not a steroid. Both kinds are prescription medicines. Transplant treatment is started and checked by a specialist transplant team.

Who should not take it, or should take care

• Do not use it if you are allergic to tacrolimus or to macrolide antibiotics such as erythromycin, clarithromycin or azithromycin.
• Capsules: do not take it together with ciclosporin (another transplant medicine). When one is changed to the other, your team will leave a gap between them.
• Capsules: tell your doctor if you have a heart rhythm problem (long QT), heart, kidney or liver disease, high blood pressure, high cholesterol, diabetes or a family history of diabetes, cystic fibrosis, or low or high potassium, calcium or magnesium.
• Ointment: tell your doctor if you have liver failure, a weak immune system, swollen glands, infected skin, skin cancer or a history of cancer, or rare skin conditions such as Netherton syndrome or widespread red, peeling skin.
• Pregnancy: advice differs. US information (MedlinePlus) says tacrolimus capsules may harm an unborn baby and asks people who can get pregnant to use effective birth control. A South African leaflet says not to take it in pregnancy. A UK NHS hospital leaflet says it is thought to be safe in pregnancy, with extra blood tests. If you take it after a transplant, plan any pregnancy with your transplant team and never stop the medicine on your own.
• Breastfeeding: advice also differs between sources. Talk to your transplant team or doctor.
• Ointment in pregnancy or breastfeeding: ask a doctor or pharmacist before using it.
• Tell your doctor or dentist that you take tacrolimus before any surgery, including dental work.
• The capsules contain lactose. Tell your doctor if you cannot digest some sugars.

Medicines and drinks that can interact

• Ciclosporin: must not be taken together with tacrolimus capsules
• Many medicines raise or lower the level of tacrolimus in the blood, so always tell your doctor and pharmacist before starting or stopping any medicine
• Antifungal medicines such as fluconazole, itraconazole, ketoconazole, voriconazole and clotrimazole
• Antibiotics such as clarithromycin and erythromycin, and rifampicin (a TB medicine)
• Epilepsy medicines such as phenytoin, phenobarbital and carbamazepine
• Some heart and blood pressure medicines, such as diltiazem, verapamil, nifedipine and amiodarone
• Some HIV and hepatitis C medicines, and the cancer medicines imatinib and nilotinib
• Stomach medicines such as omeprazole, lansoprazole, cimetidine and some antacids
• Steroids such as prednisolone, and mycophenolate
• Anti-inflammatory painkillers (NSAIDs) such as ibuprofen: only use them if your doctor says so
• Potassium supplements and water tablets that keep potassium in the body, such as spironolactone or amiloride
• Hormonal contraceptives containing ethinylestradiol can interact. One leaflet advises using a method other than the pill, so ask your team which contraception suits you.
• Live vaccines must not be given. Talk to your transplant team before any vaccine.
• Herbal products: avoid St John's wort and Schisandra extracts.
• Grapefruit and grapefruit juice: avoid them, as they can change the level of tacrolimus in your blood.
• Ointment: cimetidine may interact; moisturisers can be used, but leave a gap after the ointment as your leaflet explains.

Always tell your doctor and pharmacist about every medicine, supplement and herbal product you take.

Using it safely

• Capsules: take it exactly as your transplant team tells you, keeping to the routine on your label. Your dose depends on regular blood tests that measure the level of tacrolimus, so keep every blood test and clinic appointment.
• Capsules: do not stop taking it, even if you feel well, unless your transplant team tells you to. Stopping can cause the new organ to be rejected.
• Capsules: different tacrolimus products (standard and long-acting kinds) are not interchangeable. Make sure you get the same product every time, and tell your pharmacist or doctor if your capsules look different.
• Capsules: follow the food instructions on your label, as many products are taken on an empty stomach. Swallow capsules and long-acting tablets whole with water; do not open, crush or chew them. Do not swallow the small drying packet in the foil pack.
• If you miss a dose of the capsules, follow the advice in your leaflet or ask your pharmacist, as the advice depends on the type you take. Never take a double dose.
• Protect your skin from the sun: use a high-factor sunscreen, wear covering clothes and sunglasses, and avoid sunbeds. This applies to both the capsules and the ointment.
• Wash your hands often, avoid close contact with people who have bad infections, and prepare food safely to lower your infection risk.
• Ointment: put a thin layer only on the eczema patches, when the skin is dry. Do not cover it with bandages or wraps. Wash your hands afterwards, unless you are treating your hands. Do not bath, shower or swim straight after putting it on.
• Ointment: use it only while you have eczema symptoms, unless your doctor gives you a plan to prevent flares. See your doctor if the eczema does not get better, gets worse, or keeps coming back.
• Ointment: do not smoke or go near flames while it is on your skin or clothes, as it can catch fire.
• Do not drive or use machines if the medicine makes you dizzy or affects your eyesight.
• Store it as your leaflet says, out of the reach of children. Return unused medicine to a pharmacy.

Common questions

Is tacrolimus ointment a steroid?
No. It works in a different way, by calming the immune reaction in the skin. Doctors use it when steroid creams have not helped enough, or when using more steroid cream could cause serious side effects, such as lasting damage to the skin.

Why do I need so many blood tests with tacrolimus capsules?
The right amount of tacrolimus is different for each person, and many things, including other medicines and food, can change the level in your blood. Blood tests measure that level and check your kidneys, liver and blood cells, so your team can adjust your treatment and spot side effects early.

Can I switch to a cheaper tacrolimus product?
Only if your transplant specialist agrees and arranges it. Different tacrolimus products are not interchangeable, and a change can alter the level in your blood. Always check with your team if your capsules look different.

Can I drink alcohol while using tacrolimus?
With the ointment, alcohol can make your face red, hot and flushed. With the long-acting capsules or tablets, US advice is to avoid alcohol, while a UK hospital leaflet says small amounts are thought to be safe. Ask your doctor what is safe for you.

Does tacrolimus cause cancer?
Medicines that suppress the immune system, including tacrolimus capsules, can raise the risk of some cancers, such as lymphoma and skin cancer. For the ointment, a small number of users developed these cancers, but it is not known whether the ointment caused them. Protect your skin from the sun and tell your doctor about any new lumps, swollen glands or skin changes.

Prepared from the sources listed by the MedInfoBase team. General information, not medical advice: it gives no doses. Your doctor or pharmacist decides the medicine and dose for you.