Prograf (Tacrolimus)
Class and Category of Drug
Before you buy Prograf (Tacrolimus) online, read common information about the medication.
Chemical class: Macrolide
Therapeutic class: Immunosuppressant
Pregnancy category: C
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Drug Indications and Dosages
Before purchase Prograf (Tacrolimus) online , you must read how it works.
To prevent organ rejection in patients undergoing allogeneic liver, kidney, or heart transplantation
Instruct patient to take tacrine on an empty stomach, and advise caregiver to make sure that the patient swallows the drug.
If patient experiences gastrointestinal distress, suggest taking drug with meals. Mention that drug's effects may be delayed. Urge patient to seek assistance when walking and changing position until drug's effects are known. Instruct her to avoid potentially hazardous activities during this period.
Advise patient not to smoke because it decreases drug's effectiveness. Caution patient not to stop taking drug abruptly. Doing so may impair cognitive ability.
Inform caregiver that tacrine will become less effective as Alzheimer's disease progresses.
Urge caregiver to make sure patient returns regularly for follow-up visits and laboratory tests to monitor drug effectiveness.
Capsules
Adults having kidney transplantation. 0.2 mg/kg/day given in two equally divided doses every 12 hr beginning only after renal function has recovered (serum creatinine level of 4 mg/dl or less).
Dosage Adjustment Black patients may need higher doses after kidney transplantation.
Adults having liver transplantation. 0.10 to 0.15 mg/kg/day given in two equally divided doses every 12 hr. Administer 6 hr after transplantation. Adults having heart transplantation. 0.075 mg/kg/day given in two equally divided doses every 12 hr. Administer 6 hr after transplantation.
Children having liver transplantation. 0.15 to 0.20 mg/kg/day given in two equally divided doses every 12 hr. Administer 6 hr after transplantation.
Intravenous Infusion
Adults having kidney or liver transplantation. 0.03 to 0.05 mg/kg/day as a continuous infusion beginning no sooner than 6 hr after transplantation. Adults having heart transplantation. 0.0187 to 0.025 mg/kg/day as a continuous infusion beginning no sooner than 6 hr after transplantation. Children having liver transplantation. 0.03 to 0.05 mg/kg/day as a continuous infusion beginning no sooner than 6 hr after transplantation.
Dosage Adjustment Therapy delayed up to 48 hours or longer in patients with postoperative oliguria. For patients with hepatic or renal impairment, dosage kept at lower end of range with possible need for further reduction.
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Incompatibilities
Don't store diluted drug in PVC containers because of increased instability of tacrolimus and possible extraction of phthalates. Don't mix or coinfused tacrolimus with solutions of pH 9 or greater, such as with acyclovir or ganciclovir, because of chemical instability of tacrolimus in alkaline media.
Contraindications of Drug
Read contraindications if you want cheap Prograf (Tacrolimus) online.
Breast-feeding, hypersensitivity to tacrolimus or its components, hypersensitivity to polyoxyl 60 hydrogenated castor oil (parenteral form), ocular exposure, within 24 hours of cyclosporine therapy
Generic Drug Interactions
Drugs
aminoglycosides, amphotericin B, cisplatin, cyclosporine, other nephrotoxic drugs: Increased risk of renal impairment bromocriptine, chloramphenicol, cimetidine, cisapride, clarithromycin, clotrimazole, cyclosporine, danazol, diltiazem, erythromycin, ethinyl estradiol, fluconazole, ganciclovir, itraconazole, ketoconazole, lansoprazole, magnesium-aluminum-hydroxide, metoclopramide, methylprednisolone, nefazodone, nicardipine, nifedipine, nelfinavir, omeprazole, protease inhibitors, ritonavir, troleandomycin, verapamil, voriconazole: Possibly increased blood tacrolimus level
carbamazepine, caspofungin, phenobarbital, phenytoin, rifabutin, rifampin, sirolimus, St. John's wort: Possibly decreased blood tacrolimus level
mycophenolic acid: Possibly increased plasma mycophenolic acid level phenytoin: Possibly increased blood phenytoin level
sirolimus: Increased risk of wound healing complications, renal dysfunction, and insulin-dependent post-transplant diabetes mellitus
vaccines (live or killed): Possibly suppressed immune response and increased adverse effects of vaccine
Foods
grapefruit juice: Possibly increased blood tacrolimus trough levels in liver transplant patients
high-fat foods: Decreased absorption of oral tacrolimus
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Drugs Adverse Reactions
Central Nervous System: Asthenia, fever, dizziness, headache, hemiparesis, insomnia, jittery feeling, leukoencephalopathy, mental changes, mutism, neurotoxicity, paresthesia, posterior reversible encephalopathy syndrome, progressive multifocal leukoencephalopathy, seizures, speech disorder, stroke, syncope, tremor
Cardiovascular: Atrial and ventricular arrhythmias, cardiac arrest, chest pain, hypercholesterolemia, hyperlipemia, hypertension, hyper-triglyceridemia, myocardial hypertrophy or ischemia, MI, pericardial effusion, peripheral edema, QT-interval prolongation, tor-sades de pointes, venous thrombosis
Eyes, Ears, Nose, And Throat: Blindness, cortical blindness, deafness, hearing loss, photophobia
Endocrine: Cushingoid features, diabetes mellitus, hot flashes, hyperglycemia
Gastrointestinal: Abdominal pain, anorexia, ascites, bile duct stenosis, colitis, constipation, diarrhea, dyspepsia, enterocolitis, gastric ulcer, gastroenteritis, gastroesophageal reflux disease, hepatic impairment or toxicity, impaired gastric emptying, nausea, pancreatitis, venoocclusive liver disease, vomiting
Genitourinary: Acute renal failure, BK virus nephropathy, elevated creatinine and BUN levels, hemorrhagic cystitis, hemolyticuremic syndrome, micturition abnormality, nephrotoxicity, oliguria, renal impairment, urinary tract infection
Hematologic: Anemia, decreased platelet count, disseminated intravascular coagulation, leukocytosis, neutropenia, pancytopenia, thrombocytopenia
Musculoskeletal: Arthralgia, back pain
Respiratory: Acute respiratory distress syndrome, atelectasis, bronchitis, cough increase, dyspnea, interstitial lung disease, lung infiltration, pleural effusion, respiratory distress or failure
Skin: Flushing, malignancy, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis
Other: Anaphylaxis, cytomegalovirus infection, hyperkalemia, hypokalemia, hypomagnesemia, hypophosphatemia, impaired wound healing, lymphoproliferative or malignant disorders, multi-organ failure, opportunistic infections (including activation of latent viral infections), primary graft dysfunction, weight loss
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Nursing Considerations for Generic Drugs
Don't start tacrolimus therapy within
24 hours of cyclosporine, and vice versa. If tacrolimus or cyclosporine blood levels are elevated beyond 24 hours of either drug being discontinued, the other drug should not be started until elevation is resolved.
Be aware that intravenous tacrolimus therapy should only be given if patient can't tolerate oral tacrolimus. Patient should be switched to oral therapy as soon as possible.
Expect to give drug with adrenal corticosteroid therapy.
Dilute intravenous drug with normal saline solution or 5% dextrose to 0.004 to 0.02 mg/ml following manufacturer guidelines. Once diluted, drug should be stored in glass or polyethylene containers (not PVC, because of decreased stability and possible extraction of phthalates). Discard after 24 hours if not used.
When converting patient from parenteral to oral therapy after heart transplantation, expect to give oral form 8 to 12 hours after infusion is discontinued.
Be aware that children having liver transplantation usually need higher doses of tacrolimus than adults.
WARNING Closely monitor patient for anaphylaxis at least during first 30 minutes of intravenous administration. Make sure emergency equipment and drugs, such as aqueous solution of epinephrine and oxygen, are immediately available.
Monitor patient's blood tacrolimus trough levels regularly, as ordered. Higher trough levels increase risk of toxicity.
Monitor blood pressure, especially in patients with history of hypertension, because drug can worsen this condition.
Monitor results of liver and renal function tests, as ordered, to detect signs of decreased function.
Tacrolimus may increase serum cholesterol, lipid, and triglyceride levels.
Monitor patient's blood glucose level closely because tacrolimus may cause post-transplant diabetes mellitus with the need for insulin therapy, especially in black and Hispanic patients.
Monitor patient's serum potassium level, as ordered, because drug can alter it.
Watch for evidence of neurotoxicity, especially in patients receiving high doses of drug. Evidence of encephalopathy includes headache, impaired consciousness, loss of motor function, psychiatric disturbance, seizures, and tremors.
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Tacrolimus
Preparations
International Brand Drug Names
The information about drugs (tablets, pills, capsules, creams, solution, nasal spray, inhaler) around the world.
Proprietary Preparations
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