Common uses of Prograf (tacrolimus) in transplant care
Prograf is an immunosuppressant in the calcineurin inhibitor class, used to prevent acute and chronic rejection after solid organ transplantation. In the U.S., its core indications include prophylaxis of rejection following kidney and liver transplant, with widespread clinical use in heart transplant as part of multi‑drug regimens. By selectively inhibiting calcineurin in T‑lymphocytes, tacrolimus reduces interleukin‑2 transcription and T‑cell activation, helping your immune system tolerate the donor organ.
Prograf is typically combined with other agents—such as mycophenolate mofetil or mycophenolic acid, corticosteroids, and sometimes induction antibodies—to balance efficacy and safety. It may also be used in maintenance therapy to minimize rejection risk while allowing gradual dose reductions as clinically appropriate. Note: topical tacrolimus (for eczema) is a different formulation and should not be confused with oral Prograf used for transplant patients.
Prograf dosage and directions (immediate‑release tacrolimus)
Dosing is individualized and guided by therapeutic drug monitoring (trough levels). Typical initial total daily doses, divided every 12 hours, are often in these ranges: kidney transplant 0.1 mg/kg/day, liver transplant 0.1–0.15 mg/kg/day, and heart transplant around 0.075–0.1 mg/kg/day. Your transplant team sets targets and adjusts based on blood levels, organ function, time since transplant, interacting medications, and adverse effects.
Target trough concentrations (measured immediately before the next dose) vary by center and phase of therapy. Early post‑transplant targets commonly range from about 8–12 ng/mL for kidney and 10–15 ng/mL for liver/heart, tapering to lower maintenance ranges (for example, 5–8 ng/mL) as clinically appropriate. Never change your dose without direction from your transplant provider.
Administration tips: take Prograf at the same times every day (about 12 hours apart). Be consistent with food—taking with food can reduce absorption and increase variability, so many centers recommend taking it on an empty stomach or in a consistent manner in relation to meals. Avoid grapefruit and grapefruit juice, which can cause dangerous increases in tacrolimus levels. Swallow capsules whole; do not crush or chew. If using granules for oral suspension, follow the instructions for reconstitution precisely and discard any unused portion as directed.
Extended‑release tacrolimus products (such as Astagraf XL and Envarsus XR) are not interchangeable milligram‑for‑milligram with Prograf and have different pharmacokinetics. If your team transitions you to or from an extended‑release formulation, they will provide exact conversion instructions and recheck trough levels after the switch.
Precautions before and during Prograf therapy
Serious infections and malignancies: as a potent immunosuppressant, tacrolimus carries boxed warnings for increased risk of serious or fatal infections and for malignancies, including post‑transplant lymphoproliferative disorder (PTLD) and skin cancers. Report fevers, new lesions, weight loss, or night sweats promptly, and practice sun protection (broad‑spectrum sunscreen, protective clothing) with regular skin checks.
Organ function and metabolic monitoring: tacrolimus can cause nephrotoxicity (increased serum creatinine), neurotoxicity (tremor, headache, confusion), hypertension, electrolyte abnormalities (high potassium, low magnesium), and hyperglycemia or post‑transplant diabetes. Your team will monitor kidney and liver function, blood pressure, glucose or A1c, electrolytes, and tacrolimus levels at regular intervals. Avoid live vaccines during therapy and discuss timing of any immunizations with your care team.
Special populations: people with hepatic impairment may require lower doses and closer monitoring. During pregnancy, tacrolimus may be used when benefits outweigh risks; obstetric and transplant teams typically monitor maternal levels and fetal growth closely. Small amounts appear in breast milk; many centers consider breastfeeding possible with infant monitoring, but decisions should be individualized with your providers.
Contraindications and when Prograf should be avoided
Do not take Prograf if you have known hypersensitivity to tacrolimus or any component of the formulation. Use caution—and specialist oversight—if you have a history of significant QT prolongation, uncontrolled infections, or severe hepatic impairment. Tacrolimus should not be used interchangeably with cyclosporine; combining calcineurin inhibitors can heighten toxicity. Always inform your transplant team about all conditions and medications before starting therapy.
Possible side effects of Prograf
Common: tremor, headache, dizziness, paresthesias, insomnia, nausea, diarrhea, abdominal discomfort, and elevated blood pressure. Laboratory‑based effects include increased serum creatinine (reflecting nephrotoxicity), hyperkalemia, hypomagnesemia, and elevated blood glucose. Many of these are dose‑related and improve with dose adjustments guided by trough levels and clinical response.
Serious: neurotoxicity can present as severe tremor, confusion, seizures, or posterior reversible encephalopathy syndrome (PRES) with visual changes and headaches—seek urgent care. Hematologic and vascular complications such as thrombotic microangiopathy (including TMA/HUS) can occur, especially with other interacting agents. Infections (bacterial, viral like CMV or BK virus, fungal) may be severe; report persistent fevers, cough, urinary symptoms, or wounds that do not heal.
Long‑term risks: malignancies, particularly PTLD and skin cancers, are increased with cumulative immunosuppression. Practice rigorous sun protection and keep up with cancer screening. Mood changes, peripheral neuropathy, and gastrointestinal intolerance may persist in some patients and should be discussed with your team to optimize therapy.
Drug interactions: what to avoid with Prograf
CYP3A4/5 inhibitors can significantly raise tacrolimus levels and toxicity risk. Major examples: azole antifungals (voriconazole, posaconazole, itraconazole, fluconazole), macrolide antibiotics (clarithromycin, erythromycin), HIV/HCV protease inhibitors and boosting agents (ritonavir, cobicistat), certain calcium channel blockers (diltiazem, verapamil, nifedipine), and grapefruit or Seville orange products. If any of these are necessary, close level monitoring and dose adjustments are mandatory.
CYP3A inducers can lower tacrolimus levels and precipitate rejection. Notable inducers: rifampin and rifabutin, carbamazepine, phenytoin, phenobarbital, and St. John’s wort. Avoid over‑the‑counter herbal products unless cleared by your transplant pharmacist. Smoking can also induce metabolism in some patients; disclose tobacco use.
Additive toxicity: combining tacrolimus with other nephrotoxic agents (aminoglycosides, amphotericin B, high‑dose NSAIDs, IV contrast) increases kidney risk. Concomitant potassium supplements or potassium‑sparing diuretics (spironolactone, eplerenone) may worsen hyperkalemia. Vaccines may work less well during immunosuppression; avoid live vaccines unless directed by your team. Always provide a full medication list—including supplements—to each healthcare provider.
Missed dose: what to do if you forget Prograf
If you miss a dose and remember within about 6 hours, take it as soon as possible. If it is close to your next scheduled dose, skip the missed dose and resume your regular schedule. Do not double up. If you vomit shortly after taking a dose, contact your transplant team for instructions. On blood draw days, get your trough level before the morning dose, then take the dose immediately after the lab draw, unless your team instructs otherwise.
Overdose and emergency guidance
Symptoms of tacrolimus overdose may include severe tremor, confusion, headache, nausea, hypertension, or sudden rise in creatinine. If an overdose is suspected, call your transplant team and U.S. Poison Control (1‑800‑222‑1222) immediately, or seek emergency care. Do not induce vomiting unless instructed by professionals. There is no specific antidote; management is supportive with close monitoring, decontamination (activated charcoal if appropriate and soon after ingestion), and correction of electrolytes. Tacrolimus is not effectively removed by dialysis.
Storage and handling instructions for Prograf
Store Prograf capsules at room temperature (68–77°F or 20–25°C), protected from moisture and light, in the original packaging until use. Keep out of reach of children and pets. Do not split, crush, or open capsules. For granules used to prepare oral suspension, keep sachets dry and at room temperature; prepare the dose exactly as directed and use promptly, discarding any unused suspension per package or pharmacy instructions. Never use expired medicine, and consult your pharmacist about safe disposal.
U.S. sale and prescription policy for Prograf
In the United States, Prograf (tacrolimus) is a prescription‑only medication. It cannot be sold or dispensed legally without a valid prescription from a licensed clinician, and no reputable hospital, pharmacy, or website will provide it without appropriate medical oversight. This safeguard exists to protect transplant recipients, because tacrolimus requires individualized dosing, lab monitoring, and careful management of interactions to prevent rejection and avoid toxicity.
HealthSouth Rehabilitation Hospital of Tallahassee supports patients through legal and structured pathways to access Prograf: coordinated care with transplant physicians, medication reconciliation, therapeutic drug monitoring, prior‑authorization and insurance navigation, and dispensing through licensed hospital or specialty pharmacies. While they do not supply Prograf without a prescription, their team can help you obtain a medically appropriate prescription, secure coverage, enroll in manufacturer assistance programs when eligible, and set up reliable refills and level checks to maintain continuity of care.
If you are a transplant candidate or recipient, contact your transplant center or HealthSouth Rehabilitation Hospital of Tallahassee for guidance on evaluation, prescriptions, and ongoing management. Avoid online vendors that claim to sell Prograf without a prescription—such sources are unsafe and illegal, and products may be counterfeit or substandard.
