If you’ve had an organ transplant, your doctor may prescribe tacrolimus IR oral capsules.

This is a prescription drug that’s used in adults and some children. It helps prevent rejection of certain transplanted organs after transplant surgery.

To learn more about the uses of tacrolimus, see the “What are tacrolimus IR oral capsules used for?” section below.

Tacrolimus IR oral capsule basics

Tacrolimus is an immunosuppressant drug. It’s not a steroid.

Tacrolimus comes as immediate-release (IR) oral capsules that you’ll take by mouth. With IR medications, the contents of the drug are released quickly after their taken. This is unlike extended-release (XR) medications, which release their contents more slowly.

Read on to learn more about tacrolimus IR oral capsules’ uses, side effects, and more.

Note: Tacrolimus also comes in other forms. It’s available as an ointment that you’ll apply to your skin and a solution that your doctor will inject into your vein. And it comes as XR oral capsules and granules that you’ll dissolve in liquid and take by mouth. Only tacrolimus IR oral capsules are described in this article. If you’d like to learn about tacrolimus’ other forms, talk with your doctor or pharmacist.

Tacrolimus IR oral capsule brand-name versions

Tacrolimus IR oral capsules come in both a brand-name form and a generic form. The brand-name version of tacrolimus IR oral capsules is called Prograf.

Note: The other forms of tacrolimus have other brand-name drug versions. For instance, tacrolimus XR oral capsules come as the brand-name drug Envarsus XR. But this article focuses only on tacrolimus IR oral capsules. To learn about other versions, talk with your doctor or pharmacist.

Tacrolimus IR oral capsules are a generic drug, which means they’re an exact copy of the active drug in a brand-name medication. The brand-name medication that tacrolimus IR oral capsules are based on is called Prograf.

Generic drugs are thought to be as safe and effective as the brand-name drug they’re based on. In general, generics usually cost less than brand-name drugs do.

If you’d like to know more about using Prograf instead of tacrolimus IR oral capsules, talk with your doctor. And view this Healthline article to learn more about the differences between generic and brand-name drugs.

Like most drugs, tacrolimus IR oral capsules may cause mild or serious side effects. The lists below describe some of the more common side effects that tacrolimus IR oral capsules may cause. These lists don’t include all possible side effects.

Keep in mind that side effects of a drug can depend on:

  • your age
  • other health conditions you have
  • other medications you may be taking

Your doctor or pharmacist can tell you more about the potential side effects of tacrolimus IR oral capsules. They can also suggest ways to help reduce side effects.

Mild side effects

Here’s a short list of some of the mild side effects that tacrolimus IR oral capsules can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read tacrolimus IR oral capsules’ prescribing information.

Mild side effects of tacrolimus IR oral capsules that have been reported include:

Mild side effects of many drugs may go away within a few days or a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from tacrolimus IR oral capsules can occur, but they aren’t common. If you have serious side effects from tacrolimus IR oral capsules, call your doctor right away. However, if you think you’re having a medical emergency, you should call 911 or your local emergency number.

Serious side effects of tacrolimus IR oral capsules that have been reported include:

* For more information about this side effect, see the “Side effect focus” section below.

Side effect focus

Learn more about some of the side effects tacrolimus IR oral capsules may cause.

Boxed warnings

Tacrolimus IR oral capsules have boxed warnings. A boxed warning is a serious warning from the Food and Drug Administration (FDA). The drug’s boxed warnings are described below.

Serious infections. Taking tacrolimus may increase your risk for serious infections. These may include bacterial, viral, and fungal infections. You may also have a risk for parasitic infections when taking tacrolimus.

If you have any symptoms of infections while taking tacrolimus, talk with your doctor right away. Symptoms will vary depending on the type of infection, but they may include:

  • cough
  • fatigue (lack of energy)
  • fever or chills
  • sweating
  • muscle aches
  • redness, warmth, or pain affecting your skin

Cancer. Tacrolimus may also cause certain types of cancer. These could include skin cancer and cancer of the lymphatic system called lymphoma. The risk of cancer with tacrolimus may increase with higher doses of the drug or treatment that lasts over a longer period of time.

What might help

Your doctor will ask you if you’re having symptoms of infection while you’re taking tacrolimus. But if you develop any symptoms, tell them right away.

Your doctor may adjust your treatment plan to lower your risk for infection. And they’ll treat any infections you have, as needed.

If you have an increased risk for skin cancer with tacrolimus, your doctor will check your skin for any changes. Talk with your doctor about what to look for when watching your skin for cancer, too. Also, limit your time exposed to the sun and ultraviolet light. And be sure to wear protective clothing and sunscreen with a high sun protection factor (SPF).

Your doctor will balance the risks and benefits of tacrolimus treatment for you. They’ll prescribe the most appropriate dose and for the length of time that’s safe for you.

If you’re concerned about any side effects with tacrolimus, talk with your doctor. Don’t stop taking tacrolimus or any other medications without talking with your doctor. And don’t change your dose without talking with your doctor first.

Nephrotoxicity

Tacrolimus may damage your kidneys, which is also called nephrotoxicity. Some people may have long-term kidney damage from tacrolimus.

Taking certain medications with tacrolimus may increase your risk for kidney damage. These medications include certain drugs used to treat HIV.

Toxicity symptoms from kidney damage may include:

  • difficult or painful urination
  • increased urges to urinate

What might help

During treatment with tacrolimus, your doctor will check your kidney function. If you develop kidney damage while you’re taking tacrolimus, your doctor may lower your dose of the drug.

While you’re taking tacrolimus, you should visit your doctor often and complete all needed tests to monitor your kidneys.

Neurotoxicity

Tacrolimus can also cause brain damage, which is also sometimes called neurotoxicity. Some conditions affecting your brain that tacrolimus may cause include:

Sometimes, people may develop brain damage if the level of tacrolimus in their blood is too high.

Toxicity symptoms from brain damage may include:

What might help

Your doctor will monitor you for changes in your mental status and neurological health.

If you develop any brain problems with tacrolimus, your doctor may lower your dose of the drug. In some situations, your doctor may have you stop taking tacrolimus.

Your doctor will also check the level of tacrolimus in your blood. If your levels are above the desired range, your doctor may lower your dose of the drug.

If you feel that tacrolimus is affecting your brain, don’t stop taking it without first talking with your doctor. And do not adjust your dose without asking your doctor.

Allergic reaction

Some people may have an allergic reaction to tacrolimus IR oral capsules.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • hives
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, typically in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.

Additionally, some people with an allergy to tacrolimus may develop acute respiratory distress syndrome (ARDS). ARDS is a life threatening condition that affects your ability to breathe.

Call your doctor right away if you have an allergic reaction to tacrolimus IR oral capsules. But if you think you’re having a medical emergency, call 911 or your local emergency number.

If you’ve had an organ transplant, your doctor may prescribe tacrolimus IR oral capsules.

This is a prescription drug that’s prescribed for adults and some children. It helps prevent rejection of certain transplanted organs after transplant surgery. For this use, tacrolimus IR oral capsules are given with other immunosuppressant drugs.

Specifically, tacrolimus IR oral capsules are prescribed for:

After organ transplant surgery, your immune system may start attacking the transplanted organ. This is called organ rejection. To prevent organ rejection, your doctor may prescribe drugs such as tacrolimus that lower your immune system’s activity.

Tacrolimus IR oral capsules prevent organ rejection by lowering your immune system’s activity. The drug blocks the activity of a protein called calcineurin. Calcineurin plays a role in your immune system’s response in your body.

To learn more about how tacrolimus IR oral capsules are used, talk with your doctor. They can recommend if this drug is right for you or your child.

Find answers to some commonly asked questions about tacrolimus IR oral capsules.

Will tacrolimus levels be checked while I’m taking this drug? What happens if the levels are high?

Yes, your doctor will check the level of tacrolimus in your blood while you’re taking this drug.

You’ll need to have a specific level of tacrolimus in your blood depending on:

Checking your levels of tacrolimus allows your doctor to balance the risks of organ rejection with those of side effects from the drug.

If your tacrolimus level is too high, you may have serious side effects. But your body may reject your transplanted organ if your level is too low.

Does tacrolimus treat eczema, vitiligo, psoriasis, dermatitis, or rosacea?

Tacrolimus IR oral capsules, which this article focuses on, do not treat these conditions. But tacrolimus also comes in an ointment, called Protopic, that’s applied on skin.

Protopic is used as a second option to treat moderate to severe eczema in adults and some children. Additionally, some doctors may prescribe Protopic ointment for off-label uses. (With off-label use, a drug that’s approved for certain conditions is used for another.)

Off-label uses of Protopic include the following skin conditions:

  • vitiligo, which causes patches of skin without pigmentation
  • psoriasis, which causes thick scaley patches, on the face, body folds, and genitals
  • seborrheic dermatitis, which causes scaling and redness, on the scalp, face, and body folds
  • chronic (long-lasting) hand dermatitis, which is a rash that affects the hands
  • contact dermatitis, which is a rash caused by substances or allergens

Tacrolimus isn’t used off-label for rosacea. Tacrolimus ointment has been studied for this purpose. But more research is needed to know if it’s a safe and effective option.

If you’d like to know more about treatment options for vitiligo, eczema, psoriasis, rosacea, or dermatitis, ask your doctor.

How does tacrolimus work? What’s its half-life?

Tacrolimus IR oral capsules are used in people who’ve had an organ transplant.

This drug works by binding to a protein that blocks another protein called calcineurin. Calcineurin plays a role in your immune system’s response in your body.

The drug’s mechanism of action is to lower your immune system’s response and prevent your body from rejecting a transplanted organ.

The half-life of tacrolimus is about 2 days. This means that half of a dose of tacrolimus is removed from your body after 2 days. In general, a medication reaches very low levels in your body after four to five half-lives have passed.

What should I know about tacrolimus vs. sirolimus, cyclosporine, pimecrolimus, and other alternatives?

Like tacrolimus IR oral tablets, sirolimus (Rapamune) and cyclosporine (Neoral) are other immunosuppressants that you take by mouth.

Similar to tacrolimus, these drugs are used in people who’ve had an organ transplant to help prevent organ rejection. Depending on your age, tacrolimus IR oral capsules can be prescribed after a kidney, liver, or heart transplant.

Sirolimus is prescribed for people who’ve had a kidney transplant. In addition to kidney transplant, cyclosporine can be prescribed after the following types of transplants:

Pimecrolimus is also an immunosuppressant. But it comes as a cream called Elidel that’s used to treat mild to moderate eczema.

If you’d like to know more about these drugs and other alternatives of tacrolimus, talk with your doctor or pharmacist.

Are there any long-term side effects of tacrolimus?

Yes, there are some long-term side effects of tacrolimus.

For instance, tacrolimus can cause kidney damage. And sometimes, this can be long-term damage to the kidneys.

If you’re concerned about taking tacrolimus because of long-term side effects, talk with your doctor or pharmacist. They can tell you more about this risk.

Is tacrolimus used for lupus nephritis or hair growth?

Tacrolimus is sometimes used to treat lupus nephritis, which is a type of kidney disease related to systemic lupus erythematosus. But this is an off-label use. (With off-label use, a drug that’s approved for certain conditions is used for another.)

Use as a hair growth treatment is also an off-label use for tacrolimus. In a small study, tacrolimus lotion caused hair to grow back in people with an autoimmune disorder that causes sores on the scalp and hair loss.

If you’d like to know more about tacrolimus treatment for these uses, talk with your doctor or pharmacist.

Your doctor will explain how you should take tacrolimus IR oral capsules. They’ll also explain how much to take and how often. Be sure to follow your doctor’s instructions. Below are commonly used dosages, but always take the dosage your doctor prescribes.

Taking tacrolimus IR oral capsules

Tacrolimus comes as immediate-release (IR) oral capsules that you’ll take by mouth.

With IR medications, the contents of the drug are released quickly after their taken. This is unlike extended-release medications, which release their contents more slowly.

Tacrolimus IR oral capsules are available in these strengths:

  • 0.5 milligrams (mg)
  • 1 mg
  • 5 mg

If you have too many side effects with tacrolimus IR oral capsules, your doctor may prescribe a different form of tacrolimus. For instance, they may give you a continuous intravenous (IV) infusion of the drug. (With a continuous IV infusion, you’ll receive the drug over a period of time as an injection into your vein.)

Dosage

Your doctor will determine the dosage of tacrolimus IR oral capsules that’s right for you. Your prescribed dosage will be based on:

You’ll take tacrolimus IR oral capsules once every 12 hours.

African American people may need a higher dosage of tacrolimus IR oral capsules. In studies, higher dosages were needed in this group of people to keep their tacrolimus levels in the desired range. This may be because blood levels of tacrolimus were lower in this group after they took one dose by mouth.

Taking tacrolimus IR oral capsules with other drugs

Your doctor will prescribe tacrolimus IR oral capsules with other drugs. These drugs may include other immunosuppressants such as:

  • azathioprine (Imuran)
  • mycophenolate mofetil (Cellcept)
  • basilizimab (Simulect)
  • corticosteroids

Questions about taking tacrolimus IR oral capsules

Here are answers to some common questions about taking tacrolimus IR oral capsules.

  • What if I miss a dose of tacrolimus IR oral capsules? If you miss a dose of tacrolimus, take it as soon as you remember. If your next dose is due soon, you may need to skip the missed dose. Talk with your doctor or pharmacist if you missed a dose. They can help you figure out when to take your next dose. In some situations, your doctor may need to check your blood level of tacrolimus if you’ve missed a dose. Try to remember to take tacrolimus by setting medication reminders.
  • Will I need to use tacrolimus IR oral capsules long term? You may need to take tacrolimus IR oral capsules long term to prevent organ rejection. Talk with your doctor or pharmacist to find out how long you’ll need to take this drug.
  • Can tacrolimus IR oral capsules be chewed, crushed, or split? No, you can’t chew, crush, or split tacrolimus IR oral capsules. You also can’t open the capsule. Take tacrolimus IR oral capsules whole, as directed by your doctor. If you’re having trouble swallowing tacrolimus IR oral capsules, talk with your doctor or pharmacist. And check out these tips for swallowing pills.
  • Should I take tacrolimus IR oral capsules with food? You can take tacrolimus IR oral capsules with or without food. But taking them with a meal may affect how much medication your body absorbs. If you take tacrolimus IR oral capsules with food, you must consistently take it this way. This way, your body will be getting the same absorption with each dose.
  • How long does tacrolimus IR oral capsules take to work? Tacrolimus IR oral capsules start to work quickly to prevent organ rejection. Your doctor will check your blood level of tacrolimus to see whether you’re receiving the correct dose so the drug works to prevent organ rejection.
Questions for your doctor

You may have questions about tacrolimus IR oral capsules and your treatment plan. It’s important to discuss all your concerns with your doctor.

Here are a few tips that might help guide your discussion:

  • Before your appointment, write down questions such as:
    • How will tacrolimus IR oral capsules affect my body, mood, or lifestyle?
  • Bring someone with you to your appointment if doing so will help you feel more comfortable.
  • If you don’t understand something related to your condition or treatment, ask your doctor to explain it to you.

Remember, your doctor and other healthcare professionals are available to help you. And they want you to get the best care possible. So don’t be afraid to ask questions or offer feedback on your treatment.

Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use. To find current prices for tacrolimus IR oral capsules in your area, visit GoodRx.com.

The manufacturers of generic tacrolimus IR oral capsules don’t offer cost assistance on this drug. But other financial assistance to help you pay for tacrolimus IR oral capsules may be available.

Medicine Assistance Tool and NeedyMeds are two websites that provide resources to help reduce the cost of tacrolimus IR oral capsules. These websites also offer tools to help you find low-cost healthcare and certain educational resources. To learn more, visit their websites.

Some important things to discuss with your doctor when considering treatment with tacrolimus IR oral capsules include:

  • your overall health
  • any medical conditions you may have
  • whether you’re taking other medications

These and other considerations to discuss with your doctor are described below.

Interactions

Taking medications, vaccines, foods, and other things with a certain drug can affect how the drug works. These effects are called interactions.

Before taking tacrolimus IR oral capsules, be sure to tell your doctor about all medications you take, including prescription and over-the-counter types. Also describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with tacrolimus IR oral capsules.

Interactions with drugs or supplements

Tacrolimus IR oral capsules can interact with several types of drugs. These drugs include:

  • the antifungals ketoconazole and voriconazole (Vfend)
  • the antibiotics clarithromycin (Biaxin) and rifampin (Rimactane)
  • the immunosuppressants cyclosporin (Neoral), mycophenolate mofetil (Cellcept), and mycophenolic acid (Myfortic)
  • the HIV drugs nelfinavir (Viracept) and ritonavir (Norvir)

This list does not contain all types of drugs that may interact with tacrolimus IR oral capsules. Your doctor or pharmacist can tell you more about these interactions and any others that may occur with use of tacrolimus IR oral capsules.

Other interactions

You should avoid drinking grapefruit juice and eating grapefruit with tacrolimus IR oral capsules.

Grapefruit can increase the amount of tacrolimus your body absorbs when you take a dose of the drug. And this can lead to serious side effects. These may include toxicity in your brain and a change in your heart rhythm called QT prolongation.

You must also avoid receiving live vaccines while you’re taking tacrolimus. (Live vaccines contain weakened, but live forms of germs they’re meant to protect you from.)

Examples of live vaccines to avoid during treatment with tacrolimus include:

Before having transplant surgery and starting tacrolimus, make sure your immunizations are up to date. And before getting any vaccinations, talk with your doctor or pharmacist to make sure it’s safe for you.

Boxed warnings

Tacrolimus IR oral capsules have boxed warnings about serious infections and cancers, such as lymphoma. Boxed warnings are serious warnings from the Food and Drug Administration (FDA).

For more information about the drug’s boxed warnings, see the “What are side effects of tacrolimus IR oral capsules?” section above.

Other warnings

Tacrolimus IR oral capsules may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take tacrolimus IR oral capsules. Factors to consider include those in the list below.

  • High potassium levels. Tacrolimus may increase the level of potassium in your blood. Taking other medications that also increase your potassium level with tacrolimus may cause your level to get too high. Examples of drugs that do this include angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers, which are common blood pressure medications. Taking these drugs with tacrolimus isn’t a contraindication. But your doctor will monitor your potassium level and adjust your treatment as needed. (Contraindications are conditions or factors that could stop your doctor from prescribing the medication.)
  • Allergic reaction. If you’ve had an allergic reaction to tacrolimus IR oral capsules or any of their ingredients, you shouldn’t take the capsules. Being allergic to this medication is a contraindication to using tacrolimus IR oral capsules. Ask your doctor what other medications are better options for you.
  • High blood pressure. Tacrolimus may raise your blood pressure. In general, you can take any medication to help manage your blood pressure as long as it doesn’t interfere with tacrolimus. But you must avoid blood pressure medications that increase your potassium levels. Additionally, calcium channel blockers such as amlodipine (Norvasc) may increase the level of tacrolimus in your blood. Tell your doctor if you’re taking any blood pressure medications before taking tacrolimus. Your doctor may change your blood pressure medication to prevent an interaction with tacrolimus. And they may have you check your blood pressure more often than usual.

Tacrolimus IR oral capsules and alcohol

Some medications interact with alcohol. But tacrolimus IR oral capsules isn’t one of them.

But to be safe, ask your doctor or pharmacist about this if you’d like to drink alcohol while taking tacrolimus.

Pregnancy and breastfeeding

Read below for information about tacrolimus IR oral capsules and pregnancy and breastfeeding.

Tell your doctor if you’re pregnant or breastfeeding, or planning either, before starting tacrolimus.

Tacrolimus and pregnancy

Tacrolimus IR oral capsules may harm a pregnancy. Infants exposed to tacrolimus during pregnancy have an increased risk of premature birth. Other risks related to tacrolimus use in pregnancy include:

Additionally, tacrolimus may increase blood sugar levels in pregnant people with gestational diabetes. (This is a form of diabetes that occurs during pregnancy.) If you take tacrolimus during pregnancy and you have gestational diabetes, your doctor will have you check your blood sugar level often.

If you’re pregnant and you have high blood pressure, tacrolimus may increase your blood pressure. High blood pressure during pregnancy can lead to a complication called preeclampsia. If you take tacrolimus during pregnancy and you already have high blood pressure, your doctor will have you check your blood pressure often.

Tacrolimus pregnancy registry

If you take tacrolimus IR oral capsules during pregnancy, consider enrolling in the drug’s pregnancy registry. A pregnancy registry collects information about the effects of a drug when used during pregnancy. This helps researchers, doctors, and patients to better understand the drug’s risks if it’s used during pregnancy.

To enroll in the Transplantation Pregnancy Registry International and report effects of tacrolimus:

  • call 877-955-6877
  • visit the registry’s website

This registry is intended for both females who become pregnant and males who’ve fathered a pregnancy taking tacrolimus.*

* In this article, we use the terms “male” and “female” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

Tacrolimus and birth control needs

If you’re able to become pregnant, talk with your doctor. They can tell you about birth control options to help prevent pregnancy. They may have you start using birth control before you start tacrolimus IR oral capsules.

Both females and males with female partners who can become pregnant should also use birth control while taking this drug.*

* In this article, we use the terms “male” and “female” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

Tacrolimus and breastfeeding

Tacrolimus does pass into breast milk. But it’s not known whether tacrolimus is harmful to a breastfed child.

Don’t take more tacrolimus IR oral capsules than your doctor prescribes. Using more than this can lead to serious side effects. If you take too many tacrolimus IR oral capsules, your doctor will closely monitor you for overdose.

Symptoms of overdose

Symptoms caused by a tacrolimus overdose can include usual side effects of this drug. These include:

What to do in case you take too much tacrolimus

Call your doctor if you think you’ve taken too many tacrolimus IR oral capsules. You can also call 800-222-1222 to reach the American Association of Poison Control Centers or use its online resource. However, if you have severe symptoms, immediately call 911 (or your local emergency number) or go to the nearest emergency room.

If you’ve had an organ transplant, your doctor may prescribe tacrolimus IR oral capsules. If you have questions about this drug, talk with your doctor or pharmacist.

You doctor can tell you about other treatments you can use for your condition. Here’s a list of drugs showing alternative treatments that you might find helpful.

Some questions to consider asking your doctor about tacrolimus IR oral capsules may include:

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.