Tacrolimus
2 medicines
Tacrolimus is a calcineurin-inhibitor immunosuppressant used to prevent organ-transplant rejection and, as a skin cream, to treat eczema; it raises infection and cancer risk and needs regular blood-level, kidney, and blood-pressure monitoring.
Key facts
- Tacrolimus (sold as Prograf as a capsule and Protopic as a skin cream) is a calcineurin inhibitor: it blocks a step immune cells need to become active.
- Oral tacrolimus prevents rejection after organ transplants and has a narrow therapeutic range, so regular blood tests measure your exact level and guide dose changes.
- Suppressing the immune system raises your risk of serious infections and certain cancers, including skin cancers and lymphoma, with long-term use.
- Seek urgent care for reduced urine output, swelling, high fever, or persistent cough, which can signal kidney trouble or serious infection.
What tacrolimus treats
Oral or injected tacrolimus stops the immune system from rejecting a transplanted kidney, liver, or heart, usually combined with other immunosuppressants. Tacrolimus skin cream and ointment treat moderate to severe eczema (atopic dermatitis) when steroid creams haven't worked well enough or can't be used long-term on sensitive skin, such as the face.
How tacrolimus works
Tacrolimus blocks an enzyme called calcineurin inside immune cells. Normally, calcineurin helps trigger the signals that activate immune cells to multiply and attack. By blocking it, tacrolimus calms this immune activation, whether the goal is protecting a transplanted organ from rejection or quieting the overactive skin immune response that drives eczema.
Before you take it
- Tell your doctor about kidney or liver disease, uncontrolled high blood pressure, or a history of irregular heartbeat before starting oral tacrolimus.
- Grapefruit and grapefruit juice raise tacrolimus blood levels significantly; avoid them.
- Oral tacrolimus requires regular blood-level monitoring plus kidney function, blood pressure, and blood sugar checks, since it can affect all three.
- With topical tacrolimus, avoid excessive sun exposure and tanning beds; use sun protection on treated skin.
- Suppressing the immune system raises infection and cancer risk with long-term use of either form; report new skin lesions or persistent infections.
Side effects
Common effects include headache, tremor, nausea, and, with the cream, a burning or stinging feeling on application.
Stop and seek urgent medical care for any of these:
- Reduced urine output, swelling, or a rapid rise in blood pressure.
- Fever, chills, or persistent cough (possible serious infection).
- Unusual bruising, bleeding, or confusion.
- Any new or unusual skin lesion, especially with long-term use.
Safety essentials
- Tacrolimus's defining risk is immunosuppression: it raises the risk of serious infection and certain cancers, so blood tests and clinical monitoring continue for as long as you take it.
- Oral tacrolimus has a narrow therapeutic range: blood levels, kidney function, and blood pressure need regular checking, and levels that run too high can damage the kidneys.
- Avoid grapefruit and tell every prescriber and pharmacist you take tacrolimus, since many common drugs change its blood level.
This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.