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Tacrolimus is an immunosuppressant that can reduce your body's ability to fight infections and diseases, which might increase your risk of developing infections or certain types of cancer, such as skin cancer and lymphoma. To minimize these risks, follow your physician's guidance to take the lowest effective dose and attend all scheduled medical and laboratory appointments.

Potential Risks and Precautions:

• Cancer Risks: Prolonged use or high doses of tacrolimus, especially in individuals with a history of skin cancer or Epstein-Barr virus (EBV) infection, can increase the likelihood of developing skin or lymph node cancer. Protect yourself from sun exposure by wearing protective clothing or using sunscreen. Regularly check your skin for unusual changes or growths.

• Infection Risks: Tacrolimus can make you more susceptible to serious infections, such as kidney, liver, or brain infections. Be vigilant for symptoms like fever, chills, sweats, abdominal pain, nausea, vomiting, dark urine, or general weakness.

• High Blood Sugar: This medication may raise blood sugar levels, potentially leading to diabetes. Monitor for signs like confusion, unusual thirst or hunger, frequent urination, and fruity-smelling breath. Regular blood sugar checks might be necessary.

• Kidney Issues: Tacrolimus can cause kidney problems, affecting potassium and uric acid levels, which could lead to heart issues, gout, or kidney stones. Regular lab tests are essential. Report any abdominal pain, chest pain, or reduced urination immediately.

• Neurological Effects: High doses may result in nerve or brain problems, such as tremors, headaches, mood changes, speech difficulties, or serious conditions like delirium or seizures.

• Blood Pressure and Heart Concerns: Tacrolimus can elevate blood pressure and affect heart rhythm. Regular blood pressure monitoring is advised, and any symptoms like chest pain or fainting require immediate medical attention.

• Blood Disorders: Rarely, it can cause blood disorders, reducing red blood cell and platelet counts, leading to bleeding risks. Inform your doctor if you experience abnormal bruising, fatigue, or dizziness.

• Pregnancy and Reproductive Health: Tacrolimus may harm unborn babies or reduce sperm count. Avoid use during pregnancy, and discuss birth control with your healthcare provider. Pregnant individuals should consider enrolling in the Transplantation Pregnancy Registry.

Interactions with Other Substances:

• Vaccines: Avoid live vaccines as tacrolimus may compromise vaccine effectiveness and increase infection risk.
• Medications: Inform your healthcare provider about all medications you are taking, as some may interfere with tacrolimus, altering its effectiveness and side effects.

Emergency Actions for Overdose:

• In the case of an overdose, seek immediate medical attention or contact emergency services.

Contraindications:

• Do not use tacrolimus if you have a known allergy to it or its components, such as polyoxyl 60 hydrogenated castor oil (for injections).

Always consult your healthcare provider with any concerns or questions about your treatment with tacrolimus.

When taking this medication, some individuals may experience common side effects such as shaking, headache, diarrhea, nausea, upset stomach, loss of appetite, trouble sleeping, and numbness or tingling in the hands or feet. These symptoms are generally mild but if they persist or worsen, you should consult a healthcare provider. Other common side effects include high blood pressure, changes in electrolyte levels, infections, increased creatinine levels, swelling of the hands and feet, constipation, general pain, and low red blood cell count.

While many people do not experience serious side effects, it's important to be aware of them. Serious side effects that require immediate medical attention include mental or mood changes, dizziness, signs of kidney problems like changes in the amount of urine, pounding heartbeat, symptoms of heart failure, hearing problems, muscle pain, and signs of liver issues such as persistent nausea or vomiting, yellowing of the eyes or skin, dark urine, and abdominal pain. This medication can also very rarely cause a serious brain infection known as progressive multifocal leukoencephalopathy (PML), which requires urgent medical care.

There is also a risk of diabetes, with symptoms such as increased thirst, hunger, and frequent urination, and a very serious allergic reaction, though rare, may occur. Be alert for rash, itching, swelling, severe dizziness, or trouble breathing. Additionally, some serious side effects might include abnormal heart rhythm, serious infections, low blood cell counts, heart attack, stroke, sudden kidney injury, and nerve problems. Always seek immediate medical help if you experience severe side effects like fainting, fast or irregular heartbeat, severe dizziness, chest pain, or if you notice black stools or vomit that resembles coffee grounds. Regular monitoring of blood pressure is advised as the medication may cause an increase in blood pressure.

Tacrolimus (Prograf) can interact with a variety of medications. It is crucial to inform your healthcare provider about all the medications and supplements you are taking, whether they are prescribed, over-the-counter, or herbal. Below is a summary of potential drug interactions with Tacrolimus:

1. Medications to Avoid with Tacrolimus: Some drugs should not be used in conjunction with Tacrolimus, as they may lead to serious interactions. These include medications such as Bepridil, Cisapride, Dronedarone, Lefamulin, Mesoridazine, Mifepristone, Nelfinavir, Pimozide, Piperaquine, Posaconazole, Ritonavir, Saquinavir, Sparfloxacin, Terfenadine, Thioridazine, and Ziprasidone.

2. Medications That May Require Caution: In some cases, using Tacrolimus with certain drugs is not recommended unless necessary. If prescribed together, your doctor may need to adjust the dosage or frequency. Examples of these medications are Cyclosporine, Sirolimus, and other drugs that can impact immune response or raise potassium levels, such as amiloride and spironolactone.

3. Medications That Might Affect Tacrolimus Removal: Some drugs can alter how Tacrolimus is metabolized, potentially affecting its effectiveness. These include azole antifungals (like itraconazole and voriconazole), rifamycins (such as rifampin and rifabutin), and St. John's Wort, among others.

4. Potential Side Effect Risks: Combining Tacrolimus with certain medications may increase the risk of side effects. Your healthcare provider might need to adjust the treatment plan if you are taking medications like Danazol, Ertapenem, Lansoprazole, Nifedipine, or Tigecycline.

Always consult your healthcare provider for advice specific to your health condition and the medications you are taking.