Your child needs to take the medicine called tacrolimus (say: ta-KROE-li-mus). This information sheet explains what tacrolimus does, how to give it, and what side effects or problems your child may have when they take this medicine.
What is tacrolimus?
Tacrolimus is a medicine that lowers the body's natural immunity. The immune system is thought to be involved in a disorder which causes the kidneys to leak protein into the urine (nephrotic syndrome). If your child is having too many relapses of nephrotic syndrome, your doctor may prescribe tacrolimus. You may hear tacrolimus called FK506, FK, or by its brand name, Prograf. Tacrolimus comes in a capsule or liquid form.
Before giving tacrolimus to your child
Tell your health care professional if your child has had an allergic reaction to tacrolimus.
Talk with your doctor or pharmacist or nephrology clinic nurse if your child has any of the following conditions.
This medicine may not be right for your child if they have:
- Cancer: Tacrolimus may make cancer worse.
- An infection: Tacrolimus lowers the body's ability to fight infection.
- Chickenpox (including recent exposure) or herpes zoster (shingles): Tacrolimus may increase the risk of severe disease affecting other parts of the body
- Diabetes: Tacrolimus may increase the amount of sugar in the blood.
- Liver disease: Tacrolimus can be harmful to the liver. Your child may need a lower dose of tacrolimus.
- Hyperkalemia (high potassium blood levels): Tacrolimus can increase levels of potassium.
- Nervous system problems: Tacrolimus can make these conditions worse.
How should you give your child tacrolimus?
Follow these instructions when giving your child tacrolimus:
- Give your child tacrolimus for as long as your doctor or nephrology clinic nurse tells you, even if your child seems better.
- Talk to your child's doctor or nephrology clinic nurse before you stop giving this medicine or before you change the dose. Your child may become ill if they stop this medicine suddenly.
- Give your child tacrolimus at the same times every day (exactly as your child's doctor or pharmacist tells you). Doses should be at least 12 hours apart.
- If your child is taking liquid tacrolimus, measure the dose with the special spoon or syringe the pharmacist gave you. Shake the bottle well before you give each dose.
- Food affects how the body absorbs tacrolimus. To keep blood levels of tacrolimus the same, your child should always take tacrolimus the same way, either with food, or always without food.
What should you do if your child throws up after you give tacrolimus?
- If your child throws up in less than ½ hour, repeat the full tacrolimus dose.
- If your child throws up in ½ hour to 1 hour, give half the regular tacrolimus dose.
- If your child throws up in greater than 1 hour, do not repeat the dose. Repeat dose only once.
What should you do if your child misses a dose of tacrolimus?
- Give the missed dose as soon as you remember.
- If it is almost time for the next dose, skip the missed dose. Give the next dose at the regular time.
- Do not give your child two doses to make up for one missed dose.
- Contact the nephrology clinic nurse if your child missed more than one dose or if your child is not taking their tacrolimus.
How long does tacrolimus take to work?
It may take several weeks for tacrolimus to make a difference in your child's condition.
What are the possible side effects of tacrolimus?
Your child may have some of these side effects while they take tacrolimus. Check with your child's doctor or nephrology clinic nurse if your child continues to have any of these side effects and they do not go away or they bother your child:
- trouble sleeping
- watery bowel movements (diarrhea)
- nausea (upset stomach) and vomiting (throwing up)
- abdominal pain
Call your child's doctor or nephrology clinic nurse during office hours if your child has any of these side effects:
- loss of energy or weakness
- increased thirst or more frequent urination
- muscle tremors or twitching
- changes in mood, irritability, or confusion
- numbness and tingling
- skin rash and itching
- headache
Most of the following side effects are not common, but they may be a sign of a serious problem.
Call your child's doctor or nephrology clinic nurse right away or take your child to the Emergency Department if your child has any of these side effects:
- fever and sore throat
- unusual bleeding or bruising
- unusual tiredness or weakness
- shortness of breath or trouble breathing
- chest pain
- fast, slow, or uneven heartbeat
- black tarry stools
- seizures
What safety measures should you take when your child is using tacrolimus?
Tacrolimus lowers the body's natural immunity, which increases your child's chances of getting an infection. Watch your child closely for signs of infection such as a fever, chills, cough, and sore throat. Contact your child's doctor or nephrology clinic nurse right away if you notice any signs of infection. Your child can take the following precautions to prevent infections:
- Avoid people with infections, such as a cold or the flu.
- Avoid places that are crowded with large groups of people.
- Be careful when brushing or flossing your child's teeth.
- You/your child shouldn't touch your child's eyes or inside their nose without washing you and your child's hands first.
- Your child's nurse will review with you what to do in case of fever.
Tacrolimus may make your child's skin more likely to sunburn. Make sure your child covers their skin and head with clothing and a hat when outside. Your child should also use sunscreen. Look for a sunscreen that says it protects against the sun's ultraviolet rays, called UVA and UVB rays. The sunscreen should have a sun protection factor, called SPF, of at least 30. Ask your pharmacist to help you pick the right sunscreen.
Vaccinations
Your child should not receive any immunizations (vaccines) without your doctor's approval. Your child or anyone else in your household should not get oral polio vaccine while your child is being treated with tacrolimus. Tell your child's doctor if anyone in your household has recently received oral polio vaccine. Your child should avoid contact with anyone who has recently received this vaccine. Other live vaccines that your child should not get include measles, mumps, and rubella (MMR), and the chicken pox vaccine.
Kidney function
Tacrolimus may decrease kidney function, usually if blood levels of tacrolimus are too high. This is why blood work is checked frequently so that the dose of tacrolimus can be adjusted.
Fertility
There is a chance that tacrolimus may cause birth defects if it is taken at the time of conception or if it is taken during pregnancy. If your child is sexually active it is best that they use some kind of birth control while receiving tacrolimus. Tell the doctor or nephrology clinic nurse right away if your child may be pregnant.
Tacrolimus and diabetes
If your child is diabetic, their blood sugars may be increased. Test blood sugars regularly.
Tacrolimus and diarrhea
If your child has diarrhea, it can affect the amount of tacrolimus that is absorbed in the body. If your child has 6 watery bowel movements in 12 hours, contact the nephrology clinic nurse.
What to avoid
While taking tacrolimus, avoid grapefruit, pomelos, or tangelos or their juices. These increase the amount of tacrolimus in the blood, which may cause more side effects. Read the labels (front and back) of mixed fruit juices to ensure that they do not contain these juices.
Avoid giving antacids with tacrolimus. Less tacrolimus will be absorbed. If your child needs an antacid, wait at least 2 hours before giving tacrolimus or 2 hours after giving tacrolimus.
Drug interactions
Many other medications may change the blood levels of tacrolimus in your child's body. Check with your child's doctor, pharmacist or nephrology clinic nurse before giving your child any other medicines (prescription, non-prescription, herbal, or natural products).
What other important information should you know about tacrolimus?
- Keep all appointments at the clinic or doctor's office so that the doctor can check your child's response to tacrolimus. The doctor may need to change the dose so that your child is getting the right amount.
- Your doctor will also check for changes such as:
- high potassium levels
- low magnesium levels
- high blood sugar
- high cholesterol
- high blood pressure
- Make sure you always have enough tacrolimus to last through weekends, holidays, and vacations. Call your pharmacy at least 2 days before your child runs out of medicine to order refills.
- Keep tacrolimus at room temperature in a cool, dry place away from sunlight. Do not store it in the bathroom or kitchen.
- Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
Keep tacrolimus out of your child’s sight and reach and locked up in a safe place. If your child takes too much tacrolimus, call your local Poison Information Centre at one of these numbers. These calls are free.
- Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
- Call 1-800-463-5060 if you live in Quebec.