Overview

Tacrolimus is a medicine used to treat different conditions, including severe asthma and interstitial lung disease (ILD).

It reduces the activity of your body’s immune system. It works by slowing down how active your condition is, rather than just treating your symptoms.

When your immune system is working properly, it protects you by fighting off infection and illness. In inflammatory conditions, your immune system might attack parts of your body, such as your lungs, by mistake.

Taking tacrolimus

Tacrolimus is given as a capsule. The number of capsules you need to take (the dose) will depend on your blood test results.

Usually, you will need to take the capsules 2 times each day, with a full glass of water.

The capsules should be taken whole (not crushed or chewed) on an empty stomach. They should be taken at least 1 hour before, or 2 to 3 hours after, having food.

If you have missed a dose, take it as soon as you remember, if it is within 6 hours of your usual time.

If you have missed a dose, never take more than your regular dose to make up for it. If you think you have taken too much tacrolimus, call your specialist team or NHS 111.

There are different brands of tacrolimus, and it is important to take the same brand.

Tacrolimus does not work immediately. It might take up to 4 months before you notice any change.

It is important to keep taking tacrolimus even if it does not seem to be working. It is also important to keep taking it when your symptoms start to improve, as it will help control your condition.

Side effects of tacrolimus

Tacrolimus can cause side effects, including:

• feeling sick (nausea)
• runny poo (diarrhoea)
• tummy (abdominal) cramps
• headache
• changes to your vision

Contact your specialist team immediately if you have any new symptoms, or anything that concerns you.

Let your team know immediately if you have:

• a sore throat
• a high temperature (fever)
• flu-like symptoms
• new, or worsening, constant cough or shortness of breath
• unexplained bruising or bleeding
• yellowing of the skin or eyes (jaundice)
• the feeling that your heart is beating unusually

If any of your symptoms are severe, your doctor might ask you to stop taking tacrolimus.

Risks to taking tacrolimus

There is a slightly increased risk of some types of cancer, such as skin cancer, for people taking tacrolimus. Skin cancers can often be treated successfully when diagnosed early. Make sure you use sunscreen, and regularly check your skin for any new spots, or changes to your freckles or moles.

Tacrolimus can affect your blood count and can sometimes cause liver or kidney problems.

Tacrolimus can affect your blood sugar level, heart rate and blood pressure. Your doctor or pharmacist will arrange for you to have tests before you start treatment, and regularly while you are taking tacrolimus. These include:

• blood tests
• heart rate check
• blood pressure monitoring

Infections

As tacrolimus affects the immune system, having this treatment can make you more likely to get an infection. 

Tell your doctor, specialist pharmacist or nurse specialist immediately if you have any of these symptoms while you are having tacrolimus:

• a sore throat
• a high temperature (fever)
• any other symptoms of infection
• unexplained bruising or bleeding
• any other new symptoms, or anything else that concerns you

Follow this advice to keep your risk of infection as low as possible.

• Try to avoid close contact with people you know who have an infection.
• Wash your hands regularly, and carry a small bottle of antibacterial hand gel.
• Keep your mouth clean by brushing your teeth regularly.
• Stop smoking if you are a smoker.
• Make sure your food is stored and prepared properly.
• Try to keep your house clean and hygienic, especially the kitchen, bathroom and toilet.

Tacrolimus and other medicines

Tacrolimus might be given with other medicines to treat your condition. Before you start any new medicines, talk to your doctor or pharmacist to make sure the treatments can be taken together.

You can take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, if you need them, unless your doctor or pharmacist has told you otherwise.

You should avoid eating unpasteurised food, and drinking grapefruit juice.

You should not take medicines you buy from a pharmacy or shop, or herbal or homeopathic remedies, without talking to your specialist team first.

You should tell any other healthcare professionals treating you, such as doctors, pharmacists, dentists or nurses, that you are taking tacrolimus.

Vaccinations

Live vaccines should be avoided while you are taking tacrolimus. This includes:

• yellow fever
• bacillus Calmette-Guerin (BCG)
• measles, mumps and rubella (MMR) 

In certain situations, a live vaccine might be needed. Speak to your pharmacist or doctor about vaccinations for more advice. 

The pneumonia, yearly flu, and Shingrix vaccines are safe and recommended. If you have any questions or concerns about vaccinations, speak to a doctor, specialist pharmacist or nurse specialist treating you.

Alcohol

Tacrolimus and alcohol can both affect your liver. You should only drink alcohol in small amounts.

Government guidelines say adults should have no more than 14 units of alcohol a week. These should be spread through the week, rather than having them all in 1 session.

You should not drive or use any tools or machines if you feel dizzy or sleepy, or have problems seeing clearly after taking tacrolimus. If you are also drinking alcohol, these effects could be worse.

Pregnancy and breastfeeding

If you are planning a family, or become pregnant while taking tacrolimus, you should tell your doctor as soon as possible.

Tacrolimus can be taken if you are:

• trying to get pregnant
• trying to get someone else pregnant
• pregnant or breastfeeding