Tacrolimus

It is used to treat rheumatoid arthritis (RA) for patients who cannot tolerate or do not respond to conventional disease-modifying antirheumatic drugs (DMARDs). It is also used to treat lupus nephritis, an inflammation of the kidney that is caused by systemic lupus erythematosus (SLE).

In rheumatoid arthritis, Tacrolimus suppresses your immune system and prevents it from attacking your joints and causing inflammation. This helps to reduce symptoms of joint swelling, pain and stiffness. In the long term, it also reduces joint deformity and bone erosion from the inflammatory condition.

In lupus nephritis, Tacrolimus suppresses your immune system and prevents it from attacking your kidney. This helps to reduce kidney damage and leakage of proteins in your urine (proteinuria).

This medication may also be used for other conditions as determined by your doctor.

• Do not stop taking your medication without checking with your healthcare professional.
• This medicine should be taken on an empty stomach – either 1 hours before food, or 2 hours after. This is because food can reduce the absorption of this medication into the body.
• However, you may take it after food if you experience persistent gastric side effects. Take Tacrolimus consistently either with or without food.
• For capsules: Swallow the capsule whole, do not crush or chew. 
• For suspension: Shake the suspension before taking.
  

If you forget to take a dose, take it as soon as you remember. Then take your next dose at the usual time. Do not take two doses to make up for the missed dose.

Inform your healthcare professional if:

• You are allergic to this medication or any of the other ingredients of this medication
• You are allergic to any antibiotic belonging to the subgroup of macrolide antibiotics (e.g. Erythromycin, Clarithromycin)
• You are pregnant, planning to become pregnant, or breastfeeding
• You are taking any other medications, including supplements, traditional medications and herbal remedies e.g. St John's Wort.
• You have high blood pressure, diabetes, kidney or liver problems.
• You have an condition where there is alteration of the electrical activity of your heart, known as "QT prolongation"
• You are planning to receive any vaccines and you must avoid any live vaccinations. 
  

Avoid taking grapefruit and pomelo when you are taking this medicine as grapefruit may interact with your medicine and increase the risk of side-effects.

Inform your healthcare professional if you are taking other medications as they may interact with Tacrolimus.

Common side effects include:

• Increased blood sugar
• Your doctor may perform routine blood tests to monitor your blood sugar
• If advised by your doctor, check your blood sugar using a home testing kit regularly and bring the readings to your doctor
• Seek medical attention if you develop the following symptoms: increased thirst, frequent urination, blurred vision and/ or tiredness
• Increased potassium and/or reduced magnesium in your blood
• Your doctor will perform routine blood tests to monitor the potassium and magnesium levels in your blood
• Seek medical attention if you develop the following symptoms: chest pain, heart palpitations, irregular heartbeat, muscle weakness or cramps, nausea and vomiting
• Increased blood pressure
• Your doctor will measure your blood pressure at each visit
• (Where applicable) Check your blood pressure regularly and bring the readings to your doctor
• Increased uric acid in your blood, or gout
• Your doctor will perform routine blood tests to monitor your uric acid, as well as monitor your gout symptoms
• Seek medical attention if you develop the following symptoms: Intense joint pain and swelling (most commonly on the big toes) that comes on suddenly, especially in the middle of the night, redness and/or warmth of affected joint
• Tremors, headache, tingling/ numbness in fingers, insomnia
• Diarrhoea, nausea, vomiting, indigestion, heartburn and abdominal pain
• Drink more water when having diarrhoea and vomiting
• Infections
• Seek medical attention if you develop symptoms like prolonged diarrhoea, fever, chills, sore throat, mouth ulcers
• Kidney problems
• Seek medical attention if you develop symptoms like swelling of hands and feet, inability to pass urine
• Hair loss
• Acne (pimples)

Most of these side effects will get better or go away as your body gets used to the medication.
Inform your doctor if the side effects above become severe and bothersome.

Rare but serious side effects include:

• Tear in your abdominal wall (perforation): Symptoms of pain or swelling in abdominal area, may or may not be accompanied with chills, fever, nausea or vomiting.
• Pure red cell aplasia (very severe reduction in red blood cell counts): Symptoms include tiredness, abnormal paleness of the skin, shortness of breath, dizziness, headache, chest pain and cold hands and feet
• Progressive Multifocal Leukoencephalopathy (viral infection of cells in the brain): Symptoms include memory loss, trouble thinking, difficulty walking or loss of vision
• Posterior Reversible Encephalopathy Syndrome (PRES) (a condition that causes swelling in the some parts of the brain):  Symptoms include headache, confusion, mood changes, seizures, and visual disturbances
• Liver problem: Signs include dark urine or light coloured stools, nausea, vomiting, loss of appetite, stomach pain, yellowing of your eyes or skin
  
• QT prolongation or Torsade de Pointes (heart rhythm disturbances): Symptoms include heart palpitations, rapid pulse, dizziness, cold sweats, chest pain, shortness of breath, low blood pressure
• Cancer (blood or predominantly skin cancers) – limit or avoid sun and ultraviolet light exposure; use appropriate sunblock or protect your skin from the sun to reduce risk
  

The symptoms of a drug allergy include one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
  
• Itchy skin rashes over your whole body
  

If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

• Keep away from children
• Keep in a cool, dry place, away from direct sunlight

• Use all the capsules within 1 year of opening the aluminium wrapping. For suspension, do not use the suspension if passed the expiry stated on the bottle.