This information provides guidance about the use of tacrolimus medication to treat autoimmune hepatitis (AIH).
If you need to get in touch with a member of the Liver team, please use the contact details below:
Leeds Liver Unit
Tacrolimus preparations
There are different brands of tacrolimus and it is very important that you remain on the same brand that your hospital specialist starts you on. You must not switch between different brands unless your hospital specialist tells you to do so.
Certain brands are taken once per day, others are taken twice per day.
It is very important that you know which preparation you are on and that you do not inadvertently switch between brands. When you collect your prescription from your pharmacy, check you have received the correct brand.
1. Immediate-release tacrolimus (e.g. Adoport®/ Prograf®)
- This preparation is taken twice per day, about 12 hours apart. Choose times suitable to you e.g. 8.00 am and 8.00 pm or 10.00 am and 10.00 pm. Swallow the capsules whole with a glass of water, if possible, one hour before or two hours after food. Some patients find it easier to take with food. If you do this, it is important to take at the same time in relation to food each day.
What to do if you forget to take a dose:
If you remember within six hours of when you usually take, then take when you remember and take your next dose at the usual time. If you remember over six hours from when you usually take, forget this dose and take your next dose at the usual time.
NEVER TAKE A DOUBLE DOSE TO MAKE UP FOR MISSED DOSES
2. Prolonged-released tacrolimus (e.g. Dailiport® and Advagraf®)
- This preparation is taken once per day, in the morning. Swallow the capsules whole with a glass of water, if possible, one hour before or two hours after food. Some patients find it easier to take their tacrolimus with food. If you do this, it is important to take it at the same time in relation to food each day.
What to do if you forget to take a dose:
If you remember within 12 hours of when you usually take, then take when you remember and take your next dose at the usual time. If you remember over 12 hours from when you usually take, forget this dose and take your next dose at the usual time.
NEVER TAKE A DOUBLE DOSE TO MAKE UP FOR MISSED DOSES
Dose
The dose will be altered according to how much of the drug is in your blood, this is checked by a blood test.
The level of tacrolimus in your blood is checked when it is at its lowest i.e. before you are due to take a dose.
- Do not take tacrolimus before you have a blood test.
- If your blood tests show that you need to have your dose changed (up or down), you will be contacted.
- All types of tacrolimus preparation come in capsule form and are available as different strengths.
You will be provided with different strengths of tacrolimus to enable you to make up your dose e.g. 1.0 mg and 0.5 mg capsules.
Side-effects of tacrolimus
Tacrolimus has several side-effects but not everyone will experience them. Some of the side-effects disappear as the dose of tacrolimus is reduced over time.
Listed below are the most common side-effects
- tremor (shaking) of the hands;
- headache;
- vivid dreams;
- upset stomach;
- hair loss on head;
- numb, hot or tingly hands, feet or mouth;
- diabetes;
- high blood pressure;
- reduced kidney function.
You may notice some of these side effects yourself. Tell the doctor or pharmacist if you do as there is often a solution.
Monitoring
As mentioned, you will have the tacrolimus level in your blood checked to ensure you are on the correct dose.
Your kidney function, liver function, full blood count and blood pressure also will be monitored whilst you are on tacrolimus.
Taking other medicines with tacrolimus
Some medicines can increase or decrease your tacrolimus level in the blood. Always check with your doctor or pharmacist if you are prescribed or if you buy any new medicines over the counter, including herbal medicines.
There are various medicines that you should NOT take whilst on tacrolimus. Some examples include:
- antibiotics called erythromycin and clarithromycin;
- non-steroidal anti-inflammatory drugs such as ibuprofen or diclofenac (can affect your kidneys);
- some antifungals.
Always check with a doctor or pharmacist that any new medicine is safe for you to take. If you are in doubt, contact one of the hospital pharmacists.
You should avoid eating grapefruit or drinking grapefruit juice whilst you are taking tacrolimus because it contains a chemical that affects the level of tacrolimus in your blood
Other citrus fruits are safe to eat or drink.
Storage
Most tacrolimus preparations come in an aluminium wrap. Once this has been opened, the capsules expire after one year. Store in the original package in order to protect from moisture.
Supply
Initially you will receive tacrolimus from hospital. Once you are on a stable dose (minimum three months), we will ask your GP to take over prescribing. Subsequent supply would then come from your community pharmacy as usual.
Your community pharmacy may not keep tacrolimus in stock so they may need time to order it in for you. Please make sure you request your prescription in advance.
Pregnancy / Breastfeeding
Talk to your doctor if you are pregnant, plan to get pregnant or think you are pregnant to ensure Tacrolimus is still appropriate.
Tacrolimus is one of the safer options in pregnancy; therefore, please do not stop taking Tacrolimus if you discover you are pregnant without discussing with the team.
Tacrolimus can also be found in breast milk. If you are breastfeeding or planning to breastfeed, talk to your doctor or pharmacist before taking Tacrolimus.
Will tacrolimus affect any vaccinations?
- Live vaccinations should be avoided in patients on tacrolimus and certain non-live vaccinations may be less effective.
Which vaccinations are safe?
- The pneumonia vaccine, flu vaccine are safe and COVID vaccines are all safe and recommended in immunosuppressed patients.
How can I find out more?
This information has been written to provide general guidance about tacrolimus. If you have any further questions or concerns, please get in touch with the team using the contact details above.
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