Tacrolimus: preventing transplant rejection
Content date: 13 November 2026
Tacrolimus reduces immune activity to protect your transplant from rejection. Your transplant team adjusts your individual dose using blood tests; do not change it because results improve or you feel well.
Your next step
Check your written prescription and monitoring plan. If anything is unclear, ask your care team before changing a dose.
Get urgent help: Seek emergency care for a seizure, sudden confusion, breathing difficulty, or swelling of the face or tongue. Do not wait for a message reply.
How do I use it?
- Immediate-release products such as Prograf are usually taken twice daily; some prolonged-release products, such as Advagraf, are taken once each morning. Brands and formulations are not automatically interchangeable, even when both contain tacrolimus. Changes require transplant-team supervision and level monitoring.
- Follow your written product, timing and food instructions. These vary by product; for example, Advagraf is taken on an empty stomach according to its leaflet. Keep your relationship to meals consistent. Swallow tablets or capsules whole as directed; do not crush or open them without advice.
How do I store it?
- Use the original packaging and its temperature and after-opening expiry instructions. Protect from moisture and children; never leave it in a hot car. Check the name and strength with every refill; ask the pharmacist about any change in appearance.
What tests do I need?
- The trough level is measured just before the scheduled dose, at the time arranged by your team. Bring your dose to take after sampling as instructed, and record your last dose time. Do not delay it all day or automatically withhold other morning medicines.
- Monitoring also includes kidney and liver function, potassium, magnesium, blood glucose and blood pressure. Target levels and test intervals differ between patients and stages of follow-up.
Possible side effects: what to expect
- Hand tremor, headache or stomach upset can occur. Mention bothersome symptoms to the transplant team: checking levels and adjusting treatment may help while protecting the transplant.
- Important risks include kidney problems, high blood sugar and infection. Regular levels and blood tests help guide dosing. Long-term immunosuppression also raises some cancer risks, especially skin cancer, so follow sun-protection and screening advice. Do not stop it yourself.
Interactions and missed doses
- Avoid grapefruit, grapefruit juice and St John’s wort. Some antibiotics, antifungals and antivirals markedly change tacrolimus levels. Check every new medicine or supplement with your transplant team or pharmacist before use.
- For a missed dose, follow your product instructions; contact the team if unclear. Never double a dose. Contact the team the same day for vomiting or diarrhoea, which may change absorption and drug levels. Do not automatically repeat a vomited dose.
- Paxlovid for COVID-19 can dangerously raise tacrolimus levels. Do not start it before transplant-team review; an alternative or carefully supervised dose and level-monitoring plan may be needed. Do not stop or adjust tacrolimus yourself.
My prescribed plan - complete with the team
Brand: ........................ | Dose and how I take or use the medicine: ........................
Next dose: ........................ | Next blood tests: ........................
Team contact: ........................
Brand: ........................ | Dose and how I take or use the medicine: ........................
Next dose: ........................ | Next blood tests: ........................
Team contact: ........................
When to get help
Seek emergency care for a seizure, sudden confusion, breathing difficulty, or swelling of the face or tongue. Do not wait for a message reply.
Contact your transplant team the same day for fever, vomiting or diarrhoea, reduced urine, a new severe tremor, inability to take the medicine, or a supply running out.
Related guides
Anti-rejection medicines after liver transplantation: a practical guide
Care after liver transplantation