Prograf 1mg Capsules
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Read all of this leaflet carefully before you start taking this medicine.
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.
• If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.
Prograf® 1 mg Capsules T04113
(tacrolimus)
The name of your product is Prograf® 1 mg Capsules but will be referred to as Prograf® throughout the following:
Other strengths of this product are also available.
Patient Information Leaflet
In this leaflet:
1. What Prograf® is and what it is used for
2. Before you take Prograf®
3. How to take Prograf®
4. Possible side effects
5. How to store Prograf®
6. Further information
1. WHAT PROGRAF® IS AND WHAT IT IS USED FOR
Prograf® belongs to a group of medicines called immunosuppressants. Following your organ transplant (e.g. liver, kidney, heart), your body’s immune system will try to reject the new organ. Prograf® is used to control your body’s immune response enabling your body to accept the transplanted organ.
Prograf® is often used in combination with other medicines that also suppress the immune system.
You may also be given Prograf® for an ongoing rejection of your transplanted liver, kidney, heart or other organ or if any previous treatment you were taking was unable to control this immune response after your transplantation.
2. BEFORE YOU TAKE PROGRAF®
Do not take Prograf®
- If you are allergic (hypersensitive) to tacrolimus or any of the other ingredients of Prograf®.
- If you are allergic (hypersensitive) to any antibiotic belonging to the subgroup of macrolide antibiotics (e.g. erythromycin, clarithromycin, josamycin).
Take special care with Prograf®
- You will need to take Prograf® every day as long as you need immunosuppression to prevent rejection of your transplanted organ. You should keep in regular contact with your doctor.
- Whilst you are taking Prograf® your doctor may want to carry out a number of tests (including blood, urine, heart function, visual and neurological tests) from time to time. This is quite normal and will help your doctor to decide on the most appropriate dose of Prograf® for you.
- Please avoid taking any herbal remedies, e.g. St. John’s wort (Hypericum perforatum) or any other herbal products as this may affect the effectiveness and the dose of Prograf® that you need to receive. If in doubt please consult your doctor prior to taking any herbal products or remedies.
- If you have liver problems or have had a disease which may have affected your liver, please tell your doctor as this may affect the dose of Prograf® that you receive.
- If you have diarrhoea for more than one day, please tell your doctor, because it might be necessary to adapt the dose of Prograf® that you receive.
- Limit your exposure to sunlight and UV light whilst taking Prograf® by wearing appropriate protective clothing and using a sunscreen with a high sun protection factor. This is because of the potential risk of malignant skin changes with immunosuppressive therapy.
- If you need to have any vaccinations, please inform your doctor beforehand. Your doctor will advise you on the best course of action.
Taking other medicines
Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription and herbal remedies.
Prograf® must not be taken with ciclosporin.
Prograf® blood levels can be affected by other medicines you take, and blood levels of other medicines can be affected by taking Prograf® which may require an increase or decrease in Prograf® dose. In particular, you should tell your doctor if you are taking or have recently taken medicines with active substances like:
- antifungal medicines and antibiotics (particularly so-called macrolide antibiotics) used to treat infections e.g. ketoconazole, fluconazole, itraconazole, voriconazole, clotrimazole, erythromycin, clarithromycin, josamycin, and rifampicin
- HIV protease inhibitors e.g ritonavir
- omeprazole or lansoprazole, used for treating stomach ulcers
- hormone treatments with ethinylestradiol (e.g the oral contraceptive pill) or danazol
- medicines for high blood pressure or heart problems such as nifedipine, nicardipine, diltiazem and verapamil
- medicines known as “statins” used to treat elevated cholesterol and triglycerides
- the anti-epileptic medicines phenytoin or phenobarbital
- the corticosteroids prednisolone and methylprednisolone
- the anti-depressant nefazodone
- St. John’s Wort (hypericum perforatum)
Tell your doctor if you are taking or need to take ibuprofen, amphotericin B, or antivirals (e.g. aciclovir). These may worsen kidney or nervous system problems when taken together with Prograf®.
Your doctor also needs to know if you are taking potassium supplements or potassium-sparing diuretics (e.g., amiloride, triamterene, or spironolactone), certain pain killers (so-called NSAIDs, e.g. ibuprofen), anticoagulants, or oral medication for diabetic treatment, while you take Prograf®.
If you need to have any vaccinations, please inform your doctor beforehand.
Taking Prograf® with food and drink
You should generally take Prograf® on an empty stomach or at least 1 hour before or 2 to 3 hours after a meal. Grapefruit and grapefruit juice should be avoided while taking Prograf®.
Pregnancy and breast-feeding
If you plan to become pregnant or think that you may be pregnant, ask your doctor or pharmacist for advice before taking any medicine.
Prograf® is excreted into breast milk. Therefore you should not breast-feed whilst receiving Prograf®.
Driving and using machines
Do not drive or use any tools or machines if you feel dizzy or sleepy, or have problems seeing clearly after taking Prograf®. These effects are more frequently observed if Prograf® is taken in conjunction with alcohol use.
Important information about some of the ingredients of Prograf®
- Prograf® contains lactose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.
3. HOW TO TAKE PROGRAF®
Always take Prograf® exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure.
Make sure that you receive the same tacrolimus medicine every time you collect your prescription, unless your transplant specialist has agreed to change to a different tacrolimus medicine. This medicine should be taken twice a day. If the appearance of this medicine is not the same as usual, or if dosage instructions have changed, speak to your doctor or pharmacist as soon as possible to make sure that you have the right medicine.
The starting dose to prevent the rejection of your transplanted organ will be determined by your doctor calculated according to your body weight. Initial doses just after transplantation will generally be in the range of
0.075 - 0.30 mg per kg body weight per day
depending on the transplanted organ.
Your dose depends on your general condition and on which other immunosuppressive medication you are taking. Regular blood tests by your doctor will be required to define the correct dose and to adjust the dose from time to time. Your doctor will usually reduce your Prograf® dose once your condition has stabilised. Your doctor will tell you exactly how many capsules to take and how often.
Prograf® is taken orally twice daily, usually in the morning and evening. You should generally take Prograf® on an empty stomach or at least 1 hour before or 2 to 3 hours after the meal. The capsules should be swallowed whole with a glass of water. Take the capsules immediately following removal from the blister. Avoid grapefruit and grapefruit juice while taking Prograf®. Do not swallow the desiccant contained in the foil wrapper.
If you take more Prograf® than you should
If you have accidentally taken too much Prograf® see your doctor or contact your nearest hospital emergency department immediately.
If you forget to take Prograf®
Do not take a double dose to make up for forgotten individual doses.
If you have forgotten to take your Prograf® capsules, wait until it is time for the next dose, and then continue as before.
If you stop taking Prograf®
Stopping your treatment with Prograf® may increase the risk of rejection of your transplanted organ. Do not stop your treatment unless your doctor tells you to do so.
If you have any further questions on the use of this product, ask your doctor or pharmacist.
4. POSSIBLE SIDE EFFECTS
Like all medicines, Prograf® can cause side effects, although not everybody gets them.
Prograf® reduces your body’s own defence mechanism to stop you rejecting your transplanted organ. Consequently, your body will not be as good as usual at fighting infections. So if you are taking Prograf® you may therefore catch more infections than usual such as infections of the skin, mouth, stomach and intestines, lungs and urinary tract.
Severe effects have been reported, including allergic and anaphylactic reactions. Benign and malignant tumours have been reported following Prograf® treatment as a result of immunosuppression.
Possible side effects are listed according to the following categories:
Very common side effects are experienced in more than one in ten patients.
Common side effects are experienced in less than one in ten patients but in more than one per one hundred patients.
Uncommon side effects are experienced in less than one in one hundred patients but more than one per one thousand patients.
Rare side effects are experienced in less than one per one thousand patients but more than one per ten thousand patients.
Very rare side effects are experienced in less than one per ten thousand patients.
POM
Very common side effects:
- Increased blood sugar, diabetes mellitus, increased potassium in the blood
- Difficulty in sleeping
- Trembling, headache
- Increased blood pressure
- Diarrhoea, nausea
- Kidney problems
Common side effects:
- Reduction in blood cell counts (platelets, red or white blood cells), increase in white blood cell counts, changes in red blood cell counts
- Reduced magnesium, phosphate, potassium, calcium or sodium in the blood, fluid overload, increased uric acid or lipids in the blood, decreased appetite, increased acidity of the blood, other changes in the blood salts
- Anxiety symptoms, confusion and disorientation, depression, mood changes, nightmare, hallucination, mental disorders
- Fits, disturbances in consciousness, tingling and numbness (sometimes painful) in the hands and feet, dizziness, impaired writing ability, nervous system disorders
- Blurred vision, increased sensitivity to light, eye disorders
- Ringing sound in your ears
- Reduced blood flow in the heart vessels, faster heartbeat
- Bleeding, partial or complete blocking of blood vessels, reduced blood pressure
- Shortness in breath, changes in the lung tissue, collection of liquid around the lung, inflammation of the pharynx, cough, flu-like symptoms
- Inflammations or ulcers causing abdominal pain or diarrhoea, bleeds in the stomach, inflammations or ulcers in the mouth, collection of fluid in the belly, vomiting, abdominal pains, indigestion, constipation, flatulence, bloating, loose stools, stomach problems
- Changes in liver enzymes and function, yellowing of the skin due to liver problems, liver tissue damage and inflammation of the liver
- Itching, rash, hair loss, acne, increased sweating
- Pain in joints, limbs or back, muscle cramps
- Insufficient function of the kidneys, reduced production of urine, impaired or painful urination
- General weakness, fever, collection of fluid in your body, pain and discomfort, increase of the enzyme alkaline phosphatase in your blood, weight gain, feeling of temperature disturbed
- Insufficient function of your transplanted organ Uncommon side effects:
- Changes in blood clotting, reduction in all blood cell counts
- Dehydration, reduced protein or sugar in the blood, increased phosphate in the blood
- Coma, bleeding in the brain, stroke, paralysis, brain disorder, speech and language abnormalities, memory problems
- Blurring of the vision due to abnormality in the lens of the eye
- Impaired hearing
- Irregular heartbeat, stop of heartbeat, reduced performance of your heart, disorder of the heart muscle, enlargement of the heart muscle, stronger heartbeat, abnormal ECG, heart rate and pulse abnormal
- Blood clot in a vein of a limb, shock
- Difficulties in breathing, respiratory tract disorders, asthma
- Obstruction of the gut, increased blood level of the enzyme amylase, reflux of stomach content in your throat, delayed emptying of the stomach
- Dermatitis, burning sensation in the sunlight
- Joint disorders
- Inability to urinate, painful menstruation and abnormal menstrual bleeding
- Failure of some organs, influenza like illness, increased sensitivity to heat and cold, feeling of pressure on your chest, jittery or abnormal feeling, increase of the enzyme lactate dehydrogenase in your blood, weight loss
Rare side effects:
- Small bleeds in your skin due to blood clots
- Increased muscle stiffness
- Blindness
- Deafness
- Collection of fluid around the heart
- Acute breathlessness
- Cyst formation in your pancreas
- Problems with blood flow in the liver
- Serious illness with blistering of skin, mouth, eyes and genitals, increased hairiness
- Thirst, fall, feeling of tightness in your chest, decreased mobility, ulcer
Very rare side effects:
- Muscular weakness
- Echocardiogram abnormal
- Liver failure, narrowing of the bile vessel
- Painful urination with blood in the urine
- Increase of fat tissue
Cases of pure red cell aplasia (a very severe reduction in red blood cell counts), agranulocytosis (a severely lowered number of white blood cells) and haemolytic anaemia (decreased number of red blood cells due to abnormal breakdown) have been reported.
If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.
5. HOW TO STORE PROGRAF®
Keep out of the sight and reach of children.
Store in a dry place and keep the capsules in the original package (aluminium wrapped blister pack). Remove the capsules only when it is time to take your medicine.
Do not use the capsules 3 months after first opening the aluminium wrapper.
The product should not be used after the expiry date. This is shown on the outer carton and blister strip. If you notice signs of deterioration in your medicine, ask the advice of your pharmacist who will tell you what to do.
If your doctor decides to stop treatment, return any remaining medicine to your pharmacist for safe disposal. Only keep it if your doctor tells you to.
6. FURTHER INFORMATION
What Prograf® contains
Prograf® contains 1 mg of the active ingredient, tacrolimus.
Prograf® also contains hydroxypropylmethyl cellulose, croscarmellose sodium, lactose, gelatin, magnesium stearate, titanium dioxide (E171) and red printing ink.
What Prograf® looks like and contents of the pack
Prograf® capsules are white, opaque capsules with ‘1mg’ printed in red on the capsule head and ‘617’ plus the company logo printed in red on the capsule body.
They are available in blister packs of 60 capsules.
The blister strips are enclosed in an aluminium wrapper with a sachet containing silica gel (dessicant) to keep the medicine dry. The aluminium wrapper contained in a carton.
Manufacturer and Product Licence Holder
This medicine is manufactured by Astellas Ireland Co., Ltd, Killorglin, County Kerry, Ireland. It is procured from within the EU by the Product Licence Holder: Swinghope Limited, Brandon House, Marlowe Way, Croydon CR0 4XS and repackaged by Interport Limited, Brandon House, Marlowe Way, Croydon CR0 4XS.
PL No: 10380/1069
Leaflet revision date: 11/03/2013
Prograf® is a registered trademark of Astellas Pharma Inc, Japan.
T04113