Tacrolimus

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Tacrolimus: instructions for use and reviews

1. Release form and composition
2. Pharmacological properties
3. Indications for use
4. Contraindications
5. Method of application and dosage
6. Side effects
7. Overdose
8. Special instructions
9. Application during pregnancy and lactation
10. Drug interactions
11. Analogs
12. Terms and conditions of storage
13. Terms of dispensing from pharmacies
14. Reviews
15. Price in pharmacies

Latin name: Tacrolimus

ATX code: L04AD02

Active ingredient: tacrolimus (Tacrolimus)

Producer: Ozon LLC (Russia), Nanopharma Development LLC (Russia), Izvarino Pharma LLC (Russia)

Description and photo update: 2019-10-07

Prices in pharmacies: from 2300 rubles.

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Tacrolimus is an immunosuppressive drug, a calcineurin inhibitor.

Release form and composition

The drug is available in the form of capsules: size No. 4, gelatinous solid, opaque: dosage 0.5 mg - the body is almost white or white, the lid is yellow; dosage of 1 mg - body and lid are white or almost white; dosage 5 mg - the body is white or almost white, the lid is green; contents of capsules - compacted powder mass or powder from white to white with a yellow or brown tint (in blister strip packs: 10 pcs., in a cardboard box 1-6, 8 or 10 packs; 1 or 7 pcs., in a cardboard a pack of 1-5 or 10 packs; in cans / bottles: 60 pcs., in a cardboard box 1 can / bottle; 10-50 or 100 pcs. in a can, in a cardboard box 1 can. Each pack also contains instructions for use of Tacrolimus).

1 capsule contains:

active substance: tacrolimus monohydrate - 0.51; 1.02 or 5.11 mg, which is 0.5 in terms of tacrolimus; 1 or 5 mg, respectively;
auxiliary components: tartaric acid, croscarmellose sodium, lactose, colloidal silicon dioxide, hypromellose, magnesium stearate;
composition of the capsule body and cap: titanium dioxide, gelatin.

Additionally, the capsule caps contain: dosage 0.5 mg - quinoline yellow dye, sunset yellow dye; dosage 5 mg - indigo carmine, iron oxide yellow dye.

Pharmacological properties

Pharmacodynamics

Tacrolimus is an immunosuppressive drug, the action of which is due to the ability of its active substance to inhibit calcineurin. The effects of tacrolimus at the molecular level and its intracellular accumulation are a consequence of its binding to the cytosolic protein (FKBP 12) and the formation of the FKBP 12 - tacrolimus complex, which has a specific and competitive inhibitory effect on calcineurin. This provides calcium-dependent blocking of T-cell signaling pathways and prevents the transcription of a discrete set of lymphokine genes.

The results of experimental use of tacrolimus in vitro and in vivo indicate its high immunosuppressive activity. Against the background of the application, there is a clear decrease in the formation of cytotoxic lymphocytes, which play a major role in the transplant rejection reaction. It promotes suppression of the formation of interleukin-2, interleukin-3 and gamma-interferon, activation of T-cells, expression of the interleukin-2 receptor, T-helper-dependent proliferation of B-cells.

Pharmacokinetics

After oral administration, the absorption of tacrolimus in adult patients can range from 6 to 43%, bioavailability is on average 20-25%. Concomitant food intake reduces the rate and extent of absorption, as well as the bioavailability of tacrolimus. The absorption of the drug is not affected by the nature of bile secretion.

Plasma protein binding of tacrolimus (serum albumin, alpha _1- acid glycoprotein) is more than 98.8%. The ratio of its concentrations in whole blood to plasma is approximately 20: 1. In the systemic circulation, it binds well to erythrocytes.

Taking into account the plasma concentrations, the volume of distribution (V _d) in the equilibrium state in healthy people is about 1300 L. V _d in equilibrium, calculated from whole blood, averages 47.6 liters.

The average total clearance, calculated from concentrations in whole blood, in healthy people is 2.25 L / h.

In adult patients after liver transplantation, the clearance value was 4.1 l / h, kidney - 6.7 l / h, heart - 3.9 l / h. With a low level of hematocrit and hypoproteinemia, the unbound fraction of tacrolimus increases, and its clearance is accelerated. In addition, corticosteroids used in transplantation can also increase the metabolic rate and accelerate the clearance of tacrolimus.

The half-life (T _1/2) is long and variable, in whole blood in healthy people it averages about 43 hours.

Tacrolimus is metabolized actively in the liver, mainly with the participation of the isoenzyme CYP3A4. In addition, its metabolism actively proceeds in the intestinal wall. Of the metabolites identified in vitro, only one of them has immunosuppressive activity similar to that of tacrolimus. Other metabolites are characterized by little or no immunosuppressive effect. The pharmacological activity of tacrolimus is practically independent of metabolites due to the fact that only one metabolite is found in the systemic circulation at low concentrations.

The drug is excreted mainly through the intestines in the form of metabolites, 2% of the dose taken - through the kidneys. Up to 1% of unchanged tacrolimus is found in urine and feces.

Indications for use

The use of Tacrolimus is indicated in adult patients for the prevention and treatment of allograft rejection of the heart, liver, and kidney.

In addition, the drug is prescribed for the treatment of allograft rejection in cases of resistance to standard methods of immunosuppressive therapy in adult patients.

Contraindications

lactose intolerance, lactase deficiency, glucose-galactose malabsorption syndrome;
period of pregnancy;
breast-feeding;
hypersensitivity to the components of the drug.

Tacrolimus, instructions for use: method and dosage

Treatment with Tacrolimus should be accompanied by close supervision by suitably qualified personnel and the necessary equipment at their disposal. Prescribing a drug or making changes to immunosuppressive therapy is performed by a physician experienced in conducting such therapy in patients with transplanted organs.

The capsules are taken orally, immediately after being removed from the package, with a sufficient amount of water, on an empty stomach (1 hour before meals or 2-3 hours after meals). The daily dose is divided in half, taking half in the morning and half in the evening. If necessary, the contents of the capsules are mixed with water and administered using a nasogastric tube.

If the time for taking the next dose has been missed, you should take the drug as soon as you remember it, while taking a double dose of Tacrolimus is prohibited.

In the initial postoperative period, tacrolimus is usually used in conjunction with other immunosuppressants. The dose may vary depending on the regimen of immunosuppressive therapy. The dose of tacrolimus should be determined based primarily on the individual tolerance of the drug and the clinical assessment of the risk of rejection, and in addition, on the data of monitoring the plasma concentration of tacrolimus.

In case of clinical signs of rejection, it is necessary to adjust the regimen of immunosuppressive therapy.

In the post-transplant period, the dose of tacrolimus is usually reduced. In some cases, it is possible to prescribe tacrolimus monotherapy with discontinuation of concomitant immunosuppressive therapy. Stabilization of the patient's condition after transplantation can affect the pharmacokinetics of tacrolimus, thereby creating the need for dose adjustment.

For the treatment of rejection episodes, higher doses of the drug are used in combination with short courses of mono / polyclonal antibodies and additional therapy with corticosteroids. If signs of toxicity appear, the dose of the drug should be reduced.

Initial doses for patients switching to oral tacrolimus should be similar to those prescribed for primary immunosuppression.

Correction of the dose of the drug in special groups of patients:

patients with hepatic impairment: there may be a need to reduce the dose in order to maintain the minimum concentration of the drug within the recommended values;
patients with renal insufficiency: no dose adjustment is required, since the pharmacokinetics of tacrolimus does not change depending on renal function. But since tacrolimus has a nephrotoxic effect, careful monitoring of renal function is necessary (including control of serum creatinine concentration, creatinine clearance and urine output);
children: children usually require 1.5–2 times the adult dose to reach baseline blood levels of tacrolimus;
elderly patients: to date, there is no information on the need to adjust the dose of the drug for elderly patients.

The doctor sets the dose, frequency of admission and duration of the course of treatment individually, taking into account the clinical indications and the patient's condition. To prevent transplant rejection, it is necessary to constantly maintain the state of immunosuppression, which indicates an unlimited duration of therapy.

Kidney transplant

The initial dose of Tacrolimus for the prevention of allograft rejection in adult patients is 0.2–0.3 mg / kg per day, it must be divided into 2 doses (morning and evening). Treatment with the drug should begin within the first day after the completion of the operation.

The initial dose of the drug for the prevention of allograft rejection in children is 0.3 mg / kg per day, it must be divided into 2 doses (morning and evening).

Liver transplant

The initial dose of Tacrolimus for the prevention of allograft rejection in adult patients is 0.1–0.2 mg / kg per day, it must be divided into 2 doses (morning and evening). Treatment with the drug should begin approximately 12 hours after the completion of the operation.

The initial dose of the drug for the prevention of allograft rejection in children is 0.3 mg / kg per day, it must be divided into 2 doses (morning and evening).

Heart transplant

To prevent allograft rejection, tacrolimus in clinically stable adult patients can be used without / in conjunction with antibody induction therapy (in this case, tacrolimus can be started later). Immediately after induction with antibodies, therapy begins with a dose of 0.075 mg / kg per day, dividing it into 2 doses (morning and evening), for 5 days after the operation, as soon as the patient's clinical condition returns to normal. An alternative approach is to take the drug within 12 hours of the transplant. This option is suitable for patients with no signs of dysfunction of internal organs (for example, kidneys). In this case, tacrolimus at an initial dose of 2–4 mg per day is combined with sirolimus and corticosteroids or mycophenolate mofetil and corticosteroids.

In order to prevent allograft rejection in children, primary immunosuppression with tacrolimus after heart transplantation can be carried out both independently and in combination with antibody induction. Immediately after antibody induction, tacrolimus therapy begins with a dose of 0.1–0.3 mg / kg per day, divided into 2 doses (morning and evening).

Transplant of other organs

Dosing recommendations for tacrolimus for the treatment of rejection in patients after allotransplantation of the pancreas, lung and small intestine are based on data from selected prospective clinical trials. The initial dose of Tacrolimus after lung transplantation is 0.1–0.15 mg / kg per day, allotransplantation of the pancreas - 0.2 mg / kg per day, allotransplantation of the small intestine - 0.3 mg / kg per day.

Transfer from cyclosporine therapy

Co-administration of tacrolimus with cyclosporine can influence the half-life of cyclosporine in the direction of its increase, as well as increase the toxic effects. In this regard, caution should be exercised when transferring patients from cyclosporine to tacrolimus therapy. Treatment with the drug should be started after assessing the patient's clinical condition and blood cyclosporine concentrations. If elevated concentrations of cyclosporine in the patient's blood are detected, the transition to tacrolimus therapy should be postponed. In practice, tacrolimus is prescribed 12-24 hours after cyclosporine is discontinued. After the patient is transferred to tacrolimus therapy, it is necessary to monitor the concentration of cyclosporine in the patient's blood, since it is possible that the clearance of cyclosporine is not excluded.

Recommendations for monitoring the therapeutic blood concentration of tacrolimus

Clinical data on rejection and tolerance of Tacrolimus capsules serve as a criterion for choosing a dose of the drug in each individual patient. In order to optimize dosing, it is necessary to determine the concentration of the active substance in whole blood using immune methods [including MIFA (semi-automatic enzyme-linked immunosorbent assay on microparticles)]. Care should be taken to rely on knowledge and understanding of the assessment method used when comparing individual clinical parameters with published data on blood tacrolimus concentration.

In the postoperative period, it is important to control the minimum plasma concentrations (C _min) of tacrolimus. To determine them, you need to take blood samples 12 hours after taking the drug, that is, immediately before taking the next dose. How often the blood C _{min of} tacrolimus will need to be determined depends on the clinical need. After the dose is adjusted, the time to reach the C _{min of the} active substance in the blood can be several days, since tacrolimus is a drug with a low level of clearance. Control of C _{min of} tacrolimus in the blood should be carried out twice a week during the early post-transplant period, and subsequently - systematically during maintenance therapy. Control C_{min of} tacrolimus in the blood is also necessary after changing the dose, immunosuppression regimen or after combined use with drugs that affect the plasma concentration of tacrolimus.

According to the results of clinical studies, tacrolimus therapy is most successful in cases where the C _{min of} tacrolimus in the blood does not exceed 20 ng / ml. When clarifying the plasma tacrolimus concentration data, it is important to assess the patient's clinical condition.

In clinical practice, in the early post-transplantation period, the C _{min of} tacrolimus in whole blood after liver transplantation is usually in the range from 5 to 20 ng / ml, after kidney and heart transplantation - from 10 to 20 ng / ml. Subsequently, during maintenance therapy after kidney, liver and heart transplantation, plasma concentrations of tacrolimus vary from 5 to 15 ng / ml.

Side effects

on the part of the hematopoietic system: often (from> 1/100 to 1/1000 to 1/10 000 to <1/1000) - thrombotic thrombocytopenic purpura;
on the part of the cardiovascular system: very often (> 1/10) - arterial hypertension, arterial hypotension, myocardial ischemia, impaired peripheral circulation, tachycardia, ischemic and thromboembolic complications, bleeding; infrequently - ventricular arrhythmias, supraventricular arrhythmias, heart failure, abnormal ECG readings (electrocardiograms), cardiomyopathy, ventricular hypertrophy, palpitations, cardiac arrhythmias, pulse and / or heart rate (heart rate), deep vein thrombosis, limbs, heart attack heart failure; rarely, pericardial effusion; very rarely (<1/10 000) - echocardiogram disorders;
on the part of the blood coagulation system: infrequently - coagulopathy, impaired coagulogram parameters; rarely - hypoprothrombinemia;
from the endocrine system: very often - diabetes mellitus, hyperglycemia; rarely - hirsutism;
from the central nervous system: very often - insomnia, headache, tremor; often - dizziness, impaired consciousness, paresthesia and dysesthesia, anxiety, nightmares, disorientation, writing disorder, peripheral neuropathy, confusion, depressed mood, depression, emotional disorders, hallucinations, mental disorders, epileptoid seizures; infrequently - disorders of articulation and speech, hemorrhage, cerebrovascular accident, paresis, encephalopathy, psychotic disorders, amnesia, coma, paralysis; rarely - increased muscle tone; very rarely - myasthenia gravis;
from the organ of hearing: often - noise (ringing) in the ears; infrequently - hearing loss; rarely - sensorineural deafness; very rarely - hearing impairment;
on the part of the organ of vision: often - photophobia, eye diseases, blurred vision; infrequently - cataract; rarely blindness;
from the respiratory system: often - rhinitis, nasal congestion, shortness of breath, cough, pharyngitis, pleural effusion, pulmonary parenchymal disorders; infrequently - respiratory disorders, respiratory failure, asthma; rarely - acute respiratory distress syndrome;
from the digestive system: very often - nausea, diarrhea; often - ulceration of the oral mucosa, vomiting, dyspepsia, constipation, loose stools, stomatitis, ascites, inflammatory pathologies of the gastrointestinal tract (GIT), abdominal pain, gastrointestinal ulcers, perforation and / or bleeding, pain in the stomach and intestines, a feeling of bloating and distention in the abdomen, flatulence, symptoms of gastrointestinal disorders; infrequently - acute and chronic pancreatitis, gastroesophageal reflux disease, increased blood amylase concentration, peritonitis, impaired gastric evacuation function, paralytic intestinal obstruction (paralytic ileus); rarely - pancreatic pseudocysts, subileus;
on the part of the hepatobiliary system: often - liver dysfunction, an increase in the level of liver enzymes, damage to liver cells, cholestasis, jaundice, cholangitis, hepatitis; rarely - obliterating endophlebitis of the veins of the liver, thrombosis of the hepatic artery; very rarely - stenosis of the bile ducts, liver failure;
from the urinary system: very often - functional disorders of the kidneys; often - disorders of the bladder and urethra, acute tubular necrosis, oliguria, renal failure, urinary syndrome, acute renal failure, toxic nephropathy; infrequently - hemolytic uremic syndrome, anuria; very rarely - hemorrhagic cystitis, nephropathy;
from the side of metabolism: very often - hyperkalemia; often - decreased appetite, hypokalemia, hypomagnesemia, hypophosphatemia, hyponatremia, hypocalcemia, hyperlipidemia, hypervolemia, hyperuricemia, hypercholesterolemia, hypertriglyceridemia, metabolic acidosis, electrolyte disturbances, anorexia; infrequently - dehydration, hypoglycemia, hypoproteinemia, hyperphosphatemia;
from the musculoskeletal system: often - muscle cramps, pain in the limbs, back pain, arthralgia; infrequently - joint disorders;
from the reproductive system: infrequently - uterine bleeding, dysmenorrhea; possibly - male fertility (decrease in the number and mobility of sperm);
from the immune system: the development of allergic reactions, anaphylactic reactions;
dermatological reactions: often - itchy skin, hyperhidrosis, rash, acne, alopecia; infrequently - photosensitivity, dermatitis; rarely toxic epidermal necrolysis (Lyell's syndrome); very rarely - Stevens-Johnson syndrome;
infections and invasions: the frequency has not been established (there is not enough data to establish the frequency of occurrence of adverse reactions) - an increased risk of local and generalized bacterial, fungal, viral, protozoal infectious diseases, worsening of infectious pathologies, nephropathy associated with the VK virus (human polyomavirus 1), progressive multifocal leukoencephalopathy;
benign, malignant, unidentified neoplasms: a high risk of benign or malignant neoplasms, including skin cancer, post-transplant lymphoproliferative diseases (PTLD) associated with the Epstein-Barr virus;
complications of procedures, trauma, poisoning: often - primary graft dysfunction;
on the part of the body as a whole: often - fever, asthenia, pain, discomfort, edema, increased levels of alkaline phosphatase in the blood, impaired perception of body temperature, weight gain; infrequently - flu-like syndrome, multiple organ failure, a feeling of squeezing in the chest, disturbances in the perception of ambient temperature, deterioration of health, anxiety, increased activity of lactate dehydrogenase in the blood, decrease in body weight rarely - difficulty in movement, thirst, a feeling of stiffness in the chest, loss of balance (falling); very rarely - an increase in adipose tissue mass.

Overdose

Symptoms: nausea, vomiting, headache, urticaria, tremors, lethargy, infections, elevated serum creatinine, alanine aminotransferase, blood urea nitrogen.

Treatment: the appointment of symptomatic therapy. In case of overdose, it is recommended to use standard treatment methods. Immediately after taking a high dose of the drug, gastric lavage, activated charcoal or other adsorbent are effective. Dialysis is ineffective. In some cases, purification methods such as hemofiltration or diafiltration have shown good results in removing very high concentrations of tacrolimus from the blood. There is no specific antidote.

special instructions

The use of Tacrolimus in the initial period after organ transplantation should be accompanied by regular monitoring of parameters such as blood pressure (BP), ECG, fasting blood glucose level, neurological status of the patient, visual condition, liver and kidney function, concentration of potassium and other electrolytes, coagulogram, hematological parameters, level of proteinemia. A clinically significant change in these indicators is the basis for the correction of immunosuppressive therapy.

It should be borne in mind that the occurrence of diarrhea can cause a significant change in the concentration of tacrolimus in the blood. In this regard, it is necessary to establish careful monitoring of the level of concentration of tacrolimus in the blood when the patient develops diarrhea.

Against the background of the use of the drug, the appearance of ventricular hypertrophy or hypertrophy of the heart septum is possible. Myocardial hypertrophy in most cases occurred when the level of tacrolimus in the blood exceeded the recommended level and was reversible. In addition, risk factors for cardiomyopathy include the use of corticosteroids, the presence of arterial hypertension, previous heart disease, renal and hepatic dysfunction, infection, hypervolemia, edema in the patient. When prescribing intensive immunosuppressive therapy for patients with a high degree of risk, ECG and echocardiographic monitoring should be performed before transplantation, and then 3 and 9–12 months after surgery. A dose reduction or replacement of tacrolimus with another immunosuppressant should be considered if abnormalities are found.

Prolongation of the QT interval is possible, therefore, special care should be taken when treating patients with diagnosed or suspected congenital long QT interval syndrome.

There is a risk of developing PTLD associated with the Epstein-Barr virus, which increases with the simultaneous use of Tacrolimus with anti-lymphocytic antibodies or if the patient has the capsid antigen of the Epstein-Barr virus. For this reason, when prescribing the drug, a serological test should be performed for the presence of the Epstein-Barr virus capsid antigen. During treatment with polymerase chain reaction (PCR), it is recommended to conduct careful monitoring for the Epstein-Barr virus. It should be borne in mind that a positive PCR for the virus can persist for several months, which is not evidence of PTLD or lymphoma.

Against the background of immunosuppressive therapy, the risk of opportunistic infections associated with profound suppression of the immune system and capable of leading to severe or fatal outcomes is increased; therefore, this must be taken into account when making a differential diagnosis in patients with impaired renal function or neurological symptoms.

During the period of taking the drug, the patient should avoid exposure to direct sunlight, using means with a high protection factor. It is recommended to limit UV exposure.

Symptoms characteristic of reversible posterior encephalopathy syndrome include headache, seizures, mental and visual disturbances. When confirming the diagnosis using magnetic resonance imaging, tacrolimus should be stopped immediately, the patient should be monitored for seizures and changes in blood pressure should be monitored. In most patients, when these measures are taken, the condition is completely reversible.

Influence on the ability to drive vehicles and complex mechanisms

During the period of treatment with Tacrolimus, the appearance of visual and neurological disorders is possible, therefore, patients are advised to refrain from driving vehicles and mechanisms.

Application during pregnancy and lactation

The use of Tacrolimus capsules during gestation and breastfeeding is contraindicated.

Drug interactions

medicinal products, including herbal products, which are inducers or inhibitors of cytochrome CYP3A4: respectively, contribute to a decrease or increase in the concentration of tacrolimus in the blood;
antibiotics of the macrolide group (including erythromycin), antifungal agents (itraconazole, ketoconazole, fluconazole, voriconazole), ritonavir (a protease inhibitor of the human immunodeficiency virus): increase the bioavailability of tacrolimus due to inhibition of its intestinal metabolism, which leads to a significant increase in the concentration of tacrolimus in the blood (if necessary their co-administration should consider reducing the dose of tacrolimus);
clotrimazole, clarithromycin, josamycin, nifedipine, nicardipine, diltiazem, verapamil, danazol, ethinylestradiol, omeprazole, nefazodone: drug interactions are weak;
cortisone, ergotamine, gestodene, dapsone, lidocaine, midazolam, mefenytoin, miconazole, nilvadipine, norethindrone, tamoxifen, quinidine, bromocriptine, (triacetyl) oleandomycin: potential inhibition of tacrolimus metabolism by the indicated agents has been established in vitro;
grapefruit juice: may increase blood levels of tacrolimus, so it is recommended to avoid drinking it during treatment;
lansoprazole, cyclosporine: cause an increase in the concentration of the active substance in the blood;
preparations of St. John's wort, rifampicin, phenytoin: contribute to a significant decrease in the concentration of tacrolimus in the blood (co-administration of the drug with drugs containing St. John's wort or other plant substances that can affect the concentration of tacrolimus in the blood and have an adverse effect on its clinical effect is contraindicated);
phenobarbital: causes clinically significant interactions;
corticosteroids: maintenance doses of corticosteroids usually decrease blood levels of tacrolimus, and administration of high doses of prednisolone or methylprednisolone to treat acute rejection may increase or decrease blood levels of tacrolimus;
metamizole, carbamazepine, isoniazid: may lower blood levels of tacrolimus;
cyclosporine: additive nephrotoxic effects and synergism are observed, T _{1/2 of} cyclosporine increases (due to the fact that the interaction with cyclosporine is clinically significant, its combination with an immunosuppressant should not be allowed, and patients who were previously treated with cyclosporine should be careful);
hormonal contraceptives, phenobarbital, antipyrine: a decrease in their clearance and an increase in T _{1/2 of} phenobarbital and antipyrine are possible;
metoclopramide, cisapride, aluminum and magnesium hydroxide, cimetidine: help to increase the bioavailability of tacrolimus;
gyrase inhibitors, aminoglycosides, vancomycin, non-steroidal anti-inflammatory drugs (NSAIDs), co-trimoxazole, ganciclovir, acyclovir: the risk of their neurotoxic or nephrotoxic effects increases;
amphotericin B, ibuprofen: increase nephrotoxicity;
potassium-sparing diuretics and other potassium-containing agents (in high doses): can potentiate the development or increase of existing hyperkalemia;
NSAIDs, oral anticoagulants, oral hypoglycemic agents and other drugs that have a high degree of affinity for blood plasma proteins: a competitive interaction with tacrolimus is possible.

In addition, tacrolimus alters the body's response to vaccination, so live attenuated vaccines should not be used during treatment.

Analogs

Tacrolimus analogs are: Tacrolimus Stada, Tacrolimus-Acri, Tacrolimus-Teva, Prograf, Pangraf, Advagraf, Takrosel, Grastiva, Redinesp, Priluxid.

Terms and conditions of storage

Keep out of the reach of children.

Store at temperatures up to 25 ° C in a dark place.

Shelf life is 2 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews of Tacrolimus

There are no reviews of Tacrolimus on social media. There are publications in which transplant doctors talk about the inadmissibility of replacing one drug containing tacrolimus with another. Due to the long period of treatment and the accidental lack of the necessary drug in the pharmacy, you cannot purchase another drug to continue therapy. With uncontrolled drug change, clinically significant differences in tacrolimus exposure may cause graft rejection or an increased incidence of side effects. The change in dosage form can only be carried out by a specialist in the field of transplantation, it should be accompanied by careful monitoring of the level of tacrolimus in the blood and dose adjustment of the drug, ensuring an adequate level of systemic exposure of tacrolimus.

The price of Tacrolimus in pharmacies

The price of Tacrolimus can be:

dosage of 0.5 mg: 10 capsules per package - from 155 rubles, 20 capsules - from 310 rubles, 30 capsules - from 464 rubles, 50 capsules - from 1035 rubles;
dosage of 1 mg: 10 capsules per package - from 210 rubles, 20 capsules - from 420 rubles, 30 capsules - from 631 rubles, 50 capsules - from 2071 rubles;
dosage of 5 mg: 10 capsules per package - from 1,537 rubles, 20 capsules - from 3,075 rubles, 50 capsules - from 10,254 rubles.

Tacrolimus: prices in online pharmacies

Drug name

Price

Pharmacy

Tacrolimus 500 mcg capsule 50 pcs.

2300 RUB

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Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!