Такролимус

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GENERIC NAME: tacrolimus
BRAND NAME: Prograf
DRUG CLASS AND MECHANISM: Tacrolimus is a drug that suppresses the immune system and is used to prevent rejection of transplanted organs. Tacrolimus accomplishes its immune-suppressing effecting by inhibiting an enzyme
(calcineurin) crucial for the multiplication of T-cells, cells that are vital to the immune process. The use of oral tacrolimus allows transplantation specialists to reduce the dose of steroids which are also used to prevent rejection. This "steroid-sparing effect" is important because of the many side effects that can occur when larger doses of steroids are used for a long period of time. Tacrolimus was approved by the
FDA in April, 1994 for liver transplantation and also has been used in patients for heart, kidney, small bowel, and bone marrow transplantation.
GENERIC AVAILABLE: No
PRESCRIPTION: Yes
PREPARATIONS: Tacrolimus is available as 1mg and 5mg capsules. It also is available for intravenous use.
STORAGE: Tacrolimus should be stored at room temperature between 15° and
30°C (59° and 86°F).
PRESCRIBED FOR: Tacrolimus is used for the prevention of rejection of transplanted organs.
DOSING: Oral tacrolimus is taken twice daily. Doses vary widely and are based on blood tests that measure the amount of tacrolimus in the body.
Taking tacrolimus with food can reduce some of the abdominal pain that can occur with this medicine; however, food can reduce the amount of tacrolimus that is absorbed. This is especially true with fatty foods. Thus, tacrolimus is best taken without food. If it must be taken with food, it should be taken with non-fatty food.
DRUG INTERACTIONS: The destruction of tacrolimus by the body may be inhibited by a large number of drugs, resulting in higher blood levels of tacrolimus, and possibly increasing its side effects. Such drugs include bromocriptine (Parlodel), cimetidine (Tagamet), cisapride (Propulsid), clarithromycin (Biaxin), cyclosporine (Sandimmune; Neoral), danazol
(Danacrine), diltiazem (Cardizem; Tiazac), erythromycin, fluconazole
(Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), metoclopramide
(Reglan), methylprednisolone (Medrol), nicardipine (Cardene), troleandomycin (Tao), and verapamil (Calan; Isoptin; Verelan; Covera-HS).
Grapefruit juice also may have a similar effect on tacrolimus and should be avoided.
Other drugs can stimulate the break-down of tacrolimus, decreasing its blood concentration and possibly reducing its effectiveness. Such drugs include carbamazepine (Tegretol), nifedipine (Procardia; Adalat); phenobarbital, phenytoin (Dilantin), rifabutin, and rifampin, tacrolimus
Live virus vaccines should be avoided while receiving tacrolimus or any other medicine that suppresses the immune system since the vaccines may be less effective.
Since tacrolimus can cause hyperkalemia (high potassium in the blood), the use of tacrolimus with diuretics that also cause retention of potassium is not recommended. Such diuretics include triamterene (found in Dyazide and
Maxzide), amiloride (found in Moduretic), and spironolactone (Aldactone).
Aluminum hydroxide, which is found in many antacids, binds tacrolimus in the stomach. Aluminum-containing antacids should not be taken with tacrolimus.
PREGNANCY: Tacrolimus crosses the placenta, but there have been no adequate studies in pregnant women to assess the effects on the fetus. Among women who have received tacrolimus while pregnant, high potassium levels and kidney injury in newborns have been reported. Therefore, tacrolimus should be used during pregnancy only when it is clearly needed.
NURSING MOTHERS: Tacrolimus passes into breast milk. It is recommended that breast-feeding be discontinued while women are receiving oral tacrolimus.
SIDE EFFECTS: Tacrolimus is associated with many and various side effects.
These include baldness (which can occur in 1 in 5 patients who take it), anemia (1 in 2), loss of appetite (1 in 3), diarrhea (3 of 4), high concentrations of potassium in the blood (1 in 2), high blood presure (1 in
2), nausea (1 in 2), vomiting (1 in 4), tingling sensation in the extremities (2 in 5), itching (1 in 3), tremor (1 in 2), fever (1 in 2), headache (2 in 3), rash (1 in 4), high blood sugar concentrations (between
1 in 3 and 1 in 2), and abdominal pain (1in 4).
Other side effects may include confusion, painful joints, increased sensitivity to light, blurred vision, insomnia, infection, jaundice
(yellowing of the skin due to effects on the liver), kidney injury, swollen ankles, and seizures.

PROGRAF (tacrolimus) Capsules and Injection

July 25, 2001: Fujisawa
Revisions to the PRECAUTIONS and ADVERSE REACTIONS sections. A new
Patient’s Information leaflet is added to the PROGRAF Capsules labeling
PRECAUTIONS
*Drugs That May Decrease Tacrolimus Blood Concentrations:
Anticonvulsants Antibiotics carbamazepine rifabutin phenobarbital rifampin phenytoin
Herbal Preparations
St. John’s Wort
*This table is not all inclusive.
St. John’s Wort (hypericum perforatum) induces CYP3A4 and P-glycoprotein.
Since tacrolimus is a substrate for CYP3A4, there is the potential that the use of St. John’s Wort in patients receiving Prograf could result in reduced tacrolimus levels.
ADVERSE REACTIONS
Post Marketing
The following have been reported: increased amylase including pancreatitis, hearing loss including deafness, leukoencephalopathy, thrombocytopenic purpura, hemolytic-uremic syndrome, acute renal failure, Stevens-Johnson syndrome, stomach ulcer, glycosuria, and cardiac arrhythmia and gastroenteritis.
Patient Information
PROGRAF
(tacrolimus capsules)
Read this important information before you start using PROGRAF [PRO-graf] and each time you refill your prescription. This summary does not take the place of talking with your transplant team.
Talk with your transplant team if you have any questions or want more information about PROGRAF. You can also visit the Fujisawa Internet site at www.fujisawa.com.
What Is PROGRAF?
PROGRAF is a medicine that slows down the body’s immune system. For this reason, it works as an anti-rejection medicine.
PROGRAF helps patients who have had a liver or kidney transplant protect their new organ and prevent it from being rejected by the body.
How Does PROGRAF Protect My New Organ?
The body’s immune system protects the body against anything that it does not recognize as part of the body. For example, when the immune system detects a virus or bacteria it tries to get rid of it to prevent infection.
When a person has a liver or kidney transplant, the immune system does not recognize the new organ as a part of the body and tries to get rid of it, too. This is called "rejection." PROGRAF protects your new organ by slowing down the body’s immune system.
Who Should Not Take PROGRAF?
Do not take PROGRAF if you are allergic to any of the ingredients in
PROGRAF. The active ingredient is tacrolimus. Ask your doctor or pharmacist about the inactive ingredients.
Tell your transplant team about all your health conditions, including kidney and/or liver problems. Discuss with your transplant team the use of any other prescription and non- prescription medications, including any herbal or over-the-counter remedies that you may take while on Prograf. In very rare cases you may not be able to take Prograf.
Tell your transplant team if you are pregnant, planning to have a baby or are breastfeeding. Talk with your transplant doctor about possible effects
PROGRAF could have on your child. Do not nurse a baby while taking PROGRAF since the medicine will be in the breast milk.
How Should I Take PROGRAF?
PROGRAF can protect your new kidney or liver only if you take the medicine correctly.
Your new organ needs around-the-clock protection so your body does not reject it. The success of your transplant depends a great deal upon how well you help PROGRAF do its job. Here is what you can do to help.
Take PROGRAF exactly as prescribed
It is important to take PROGRAF capsules exactly as your transplant team tells you to.
PROGRAF comes in several different strength capsules--0.5 mg, 1 mg and 5 mg. Your transplant team will tell you what dose to take and how often to take it. Your transplant team may adjust your dose until they find what works best for you.
Never change your dose on your own. Never stop taking PROGRAF even if you are feeling well. However, if you feel poorly on Prograf, discuss this with your transplant team.
Take PROGRAF two times a day, 12 hours apart
Try to pick times that will be easy for you. For example, if you take your first dose at 7:00 a.m. you should take your second dose at 7:00 p.m. Do not vary the times. You must take PROGRAF at the same times every day. If you decide to take PROGRAF at 7:00 a.m. and 7:00 p.m., take it at these same times every day. This will make sure you always have enough medicine in your body to give your new organ the around-the-clock protection it needs.
Take PROGRAF the same way each day
Some people prefer to take PROGRAF with food to help reduce possible stomach upset. Whether you take PROGRAF with or without food, it is important to take PROGRAF the same way every day. For example, if you take
PROGRAF with food, you should always take it with food. Do not eat grapefruit or drink grapefruit juice in combination with your medicine unless your transplant teams approves. Do not change the way you take this medicine without telling your transplant team, since this could change the amount of protection you get from PROGRAF.
Take all your doses
It is important to take your doses twice a day exactly as prescribed by your doctor. If you miss even two doses, your new liver or kidney could lose the protection it needs to defend itself against rejection by your body.
If you miss one dose, do not try to catch up on your own. Call your transplant team right away for instructions on what to do.
If you travel and change time zones, be sure to ask your transplant team how to adjust your dosage schedule so your new organ does not lose its protection.
Plan ahead so that you do not run out of PROGRAF
Make sure you have your prescription for PROGRAF refilled and at home before you need it. Circle the date on a calendar when you need to order your refill. Allow extra time if you receive your medicines through the mail.
Your transplant team will follow your progress and watch for early signs of side effects. This is why you will have blood tests done often after your transplant. On the days you are going to have a blood test to measure the amount of PROGRAF in your body, your transplant team may ask you not to take your morning dose until after the blood sample is taken. Check with your transplant team before skipping this dose.
Can Other Medicines Affect How PROGRAF Works?
Some medicines and alcohol can affect how well PROGRAF works. After you start taking PROGRAF:
Be sure to tell your transplant team, family doctor, dentist, pharmacist and any other health care professional treating you the names of all the medicines you are taking. This includes PROGRAF as well as all other prescription medicines and non- prescription medicines, natural or herbal remedies, nutritional supplements, and vitamins. This is the only way that your health care team can help prevent drug interactions that could be serious.
Always check with your transplant team before you start taking any new medicine.
While you are taking PROGRAF, do not get any vaccinations without your transplant team’s approval. The vaccination may not work as well as it should.
Liver transplant patients, including those taking PROGRAF, should not drink alcohol.
What Are the Possible Side Effects of PROGRAF?
Tell your transplant team right away if you think you might be having a side effect. Your transplant team will decide if it is a medicine side effect or a sign that has nothing to do with the medicine but needs to be treated. Infection or reduced urine can be signs of serious problems that you should discuss with your transplant team.
Your transplant team will also follow your progress and watch for the early signs of any side effects. This is why you will have blood tests done often during the first few months after your transplant. On the days you are going to have a blood test to measure the amount of PROGRAF in your body, your transplant team may ask you not to take your morning dose until after the blood sample is taken. Check skipping this dose.
For Kidney Transplant Patients:
The most common side effects of PROGRAF for kidney transplant patients are infection, headache, tremors (shaking of the body), diarrhea, constipation, nausea, high blood pressure, changes in the amount of urine, and trouble sleeping.
Less common side effects are abdominal pain (stomach pain), numbness or tingling in your hands or feet; loss of appetite; indigestion or "upset stomach"; vomiting; urinary tract infections; fever; pain; swelling of the hands, ankles or legs; shortness of breath or trouble breathing; cough; leg cramps; heart "fluttering", palpitations or chest pain; unusual weakness or tiredness; dizziness; confusion; changes in mood or emotions; itchy skin, skin rash, and diabetes.
For Liver Transplant Patients:
The most common side effects of PROGRAF for liver transplant patients are headache, tremors (shaking of the body), diarrhea, high blood pressure, nausea and changes in the amount of urine.
Less common side effects are numbness or tingling in your hands or feet; trouble sleeping; constipation; loss of appetite; vomiting; urinary tract infections; fever; pain (especially in the back or abdomen [stomach area]); swelling of the hands, ankles, legs or abdomen; shortness of breath or trouble breathing; cough; unusual bruising; leg cramps; heart "fluttering" or palpitations; unusual weakness or tiredness; confusion; changes in mood or emotions; itchy skin, and skin rash.