What does it do?

Tacrolimus is an immunosuppressant used with other medicines to prevent transplant rejection.

Before you start

• Tacrolimus weakens your immune system, making it harder for your body to fight infections. You may need tests before you start to make sure you don't have any infections like tuberculosis (TB), HIV, or hepatitis B and C.
• Ask your doctor what vaccines you might need before you start and while you are taking tacrolimus. You should not have a live vaccine while taking tacrolimus.
• If you plan to become pregnant, or find you are pregnant, discuss this with your doctor. Use reliable contraception while taking tacrolimus. Tell your doctor if you are breastfeeding.

How should you take it?

Take tacrolimus regularly as directed. You can take tacrolimus with or without food, but take it the same way each time.

What if you forget a dose?

Take the missed dose as soon as possible. If it is close to the time for your next dose, skip the missed dose and carry on as normal. Do not take two doses at the same time.

Can you take other medicines?

Some medicines available without a prescription may react with tacrolimus including:

• anti-inflammatories, such as diclofenac (e.g. Voltaren®), ibuprofen (e.g. Nurofen®), or aspirin (e.g. Disprin®, in doses used for pain relief). These can also be found in some cold and flu medicines (e.g. Nurofen Cold and Flu®).

Tell your pharmacist or doctor about all medicines or treatments that you may be taking, including vitamins, herbal products (e.g. St John's wort, echinacea) or recreational drugs.

What side effects might you notice?

Side Effects	Recommended action
Reduced number of blood cells that fight infections or help your blood to clot - symptoms include: fever, chills, sore throat or generally feeling unwell, or easy or unusual bruising or bleeding Fast or irregular heartbeat, chest pain Seizures	Tell your doctor immediately
Dizziness, pale skin Hearing loss, ringing in the ears Peeing more often, feeling thirsty Swollen feet or legs, short of breath Increased blood pressure	Tell your doctor
Headache, trouble sleeping Cough Joint, muscle or bone aches and pains, tremor, tingling or numbness Acne, hair loss or thinning Nausea, vomiting, diarrhoea, constipation	Tell your doctor if troublesome

If you notice any other effects, discuss them with your doctor or pharmacist.

Other information:

• Do not stop taking tacrolimus unless your doctor at the transplant clinic tells you to. You may have to take tacrolimus for the rest of your life.
• You will need regular blood tests to measure the amount of tacrolimus in your blood. On the morning of the blood test, do not take your regular dose of tacrolimus until after the blood has been taken. Other blood tests will monitor how your kidneys are working and your cholesterol levels (tacrolimus can increase cholesterol).
• Protect yourself from too much sunlight while taking immunosuppressant medicines (they may increase your risk of skin cancer). Always cover up and apply a thick layer of broad spectrum sunscreen (at least SPF30) when outside. Do not use sunbeds.
• Women using tacrolimus for a long time may need cervical screening more often. Discuss with your doctor.
• It is important to tell anyone who gives you medical or dental treatment that you are taking tacrolimus.
• Grapefruit, grapefruit juice or sour/Seville oranges may react with tacrolimus. Discuss with your pharmacist.