Tacrolimus (Prograf®)

Store your medication in the original container with the label. If you want to use a pillbox, talk to your pharmacist. Keep it in a dry place at room temperature unless your provider or pharmacist tells you otherwise. Keep containers out of reach of children and pets.

If a caregiver prepares your dose for you, they should consider wearing gloves or pour the pills directly from their container into the cap, a small cup, or directly into your hand. They should avoid touching the pills. They should always wash their hands before and after giving you the medication. Pregnant or nursing people should not prepare the dose for you. Ask your provider where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash. 

This medication may be covered by your prescription plan. If you qualify, you may be able to get financial help through patient assistance programs (PAP). Co-pay cards may also be available to lower your out-of-pocket cost if you have commercial (not Medicare/Medicaid/Tricare) insurance. Your pharmacist, social worker, or navigator can help find resources for financial support.

These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.

This medication increases your risk for infection. You should let your provider know right away if you have:

• A fever. Call for a temperature over 100.4°F or 38°C or as directed by your provider.
• Sore throat or cold.
• Shortness of breath.
• A cough.
• Burning with urination.
• A sore that doesn't heal.

The most common infection related to this medication is a urinary tract infection. Symptoms may be:

• Having to go to the bathroom often.
• A strong urge to urinate.
• Burning with urination.

Tips for preventing infection:

• Washing your hands is the best way to prevent the spread of infection.
• Ask your visitors to wash their hands too.
• Avoid large crowds and people who are sick (i.e., those who have a cold, fever, or cough, or live with someone who is sick).
• When working in your yard, wear protective clothing, like long pants and gloves.
•  Do not handle pet waste.
• Keep your cuts and scratches clean.
• Shower or bathe daily and do frequent mouth care like brushing and flossing.
• Do not cut your cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Talk to your provider before scheduling dental appointments or procedures.
• Ask your provider before you or someone you live with gets any vaccinations.

This medication can cause high blood pressure (hypertension). You should have your blood pressure checked often during therapy, so that if you have high blood pressure, it can be treated. If your blood pressure cannot be controlled, your provider may want you to stop taking the medication. Tell your providers about any headaches, vision changes, or dizziness. 

This medication can cause kidney problems, like an increased creatinine level. Your provider may monitor for kidney problems with blood tests. Symptoms may be:

• Less urine output than normal.
• Blood in the urine.
• Swelling in the ankles.
• Loss of appetite.

Tell your provider if you have any of these symptoms.

Diarrhea is when you pass three or more stools in a day. Your providers can suggest medications to relieve diarrhea. Do not take any medications to manage your diarrhea without talking to your provider first, as your stool may need to be tested. To manage it, try eating foods that are low in fiber and bland, like white rice and boiled or baked chicken. Try not to eat raw fruits, vegetables, whole grain breads, cereals, and seeds. Soluble fiber is a type of fiber found in some foods that helps absorb (soak up) fluid. Foods high in soluble fiber are applesauce, bananas (ripe), canned fruit, oranges, boiled potatoes, white rice, foods made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Stay hydrated by drinking 8 to 10 glasses of non-alcoholic, non-caffeinated fluid each day.

Talk to your providers if you have nausea and/or vomiting. They can prescribe medications to help you. Making changes to your diet can also help. Avoid things that make your symptoms worse, like heavy or greasy/fatty foods and spicy or acidic foods, like tomatoes, lemons, and oranges. Try saltines or ginger ale to help your symptoms.  

Call your providers if you cannot keep fluids down for more than 12 hours or if you feel lightheaded or dizzy.

Constipation is when you have less bowel movements than usual or are having trouble passing stool. To relieve constipation, you can include fiber in your diet (fruits like prunes, apples, peaches, and pear nectars/juices), drink 8 to 10 glasses of non-alcoholic fluids a day, and stay active. Taking a stool softener once or twice a day can prevent constipation. If you do not have a bowel movement for 2 to 3 days, call your provider. 

Insomnia is when there is a change in your sleep habits. This medication can cause new or worsening insomnia. Symptoms may be:

• Having a hard time falling asleep.
• Having a hard time staying asleep.
• Waking often through the night.
• Feeling unrested the next day.

Talk with your provider if changes to sleep are affecting your daily life.

Peripheral edema is swelling in your hands, arms, legs, ankles, and feet. It is caused by retention (buildup) of fluid. To help get rid of the fluid, you can elevate (lift up) the affected body part and rest it on a pillow. You may need medications to help your body get rid of the extra fluid, and you may be told to follow a low salt diet. Tell your providers if you have any new or worsening swelling.

This medication may cause a fever. Ask your provider what temperature to watch for and when to call.

You may have joint or muscle pain:

• Arthralgia pain is like arthritis pain. It can cause morning stiffness, and you may feel it in your joints at different times during the day. It can also cause pain in your elbows, shoulders, wrists, knees, feet, pelvic and hip bones, or back.
• Myalgia is pain or aching in your muscles. 

Your providers can recommend medication and other ways to relieve pain.

This medication may affect your fertility. It can cause changes to your menstrual cycle or sperm. You may want to consider sperm banking or egg harvesting if you might wish to have a child in the future. Talk about your options with your provider before treatment.

This medication can cause high blood sugar in patients with and without diabetes. Symptoms can be:

• Feeling more thirsty.
• More frequent urination.
• Feeling hungrier. 
• Blurry vision.
• Headaches.
• Breath smelling like fruit.

All patients will have their blood sugar checked with blood tests. If you have diabetes and your blood sugars are higher than normal, talk to your provider. Tell your provider if you have any of these symptoms.

Hyperlipidemia is a higher-than-normal level of lipids in your blood. This can happen while on this medication. Your provider will monitor your blood levels during and after treatment.