Tacrolimus — NZ Medication Guide
📋 Reviewed by a Registered Pharmacist NZ — This information is for general educational purposes only and does not replace professional medical advice. Always consult your doctor or pharmacist before starting, stopping, or changing any medication.
What is Tacrolimus?
Tacrolimus is a calcineurin inhibitor immunosuppressant used for organ transplant rejection prevention and severe autoimmune skin conditions. This medication is funded by Pharmac for transplantation under Special Authority.
What is Tacrolimus Used For?
Tacrolimus is used as the primary calcineurin inhibitor for prevention of rejection after solid organ transplantation (kidney, liver, heart, lung). Topical tacrolimus (Protopic® ointment) is used for moderate-to-severe atopic dermatitis (eczema) when topical steroids are not appropriate.
How Does Tacrolimus Work?
Tacrolimus binds to the intracellular immunophilin FKBP12, and this complex inhibits calcineurin — blocking IL-2 transcription and T cell activation. It is approximately 100 times more potent than ciclosporin at equivalent concentrations.
How to Take Tacrolimus
Systemic: oral capsules (Prograf® 0.5 mg, 1 mg, 5 mg) twice daily, dosed based on target trough levels. Astagraf XL® (extended-release) is taken once daily. Blood level monitoring is mandatory. Topical (Protopic® 0.03%, 0.1% ointment): apply twice daily to affected areas of eczema.
Common Side Effects of Tacrolimus
- Nephrotoxicity
- Neurotoxicity (tremor, headache — more than ciclosporin)
- Hyperglycaemia and new-onset diabetes after transplant (NODAT)
- Hypertension
- Alopecia (hair loss)
- GI symptoms
Serious Side Effects — Seek Medical Attention
Contact your doctor or call 111 immediately if you experience any of the following:
- Nephrotoxicity (primary long-term concern)
- New-onset diabetes mellitus post-transplant (common — up to 20%)
- Serious infections (bacterial, viral, fungal, opportunistic)
- Lymphoma and skin malignancy
- Neurotoxicity including leukoencephalopathy (rare)
- QT prolongation
Drug Interactions
Tacrolimus may interact with other medicines. Always inform your doctor and pharmacist of all medications you are taking. Key interactions include:
- MANY interactions — especially CYP3A4 and P-gp substrates (same issues as ciclosporin)
- Grapefruit juice (markedly increases levels — avoid)
- CYP3A4 inhibitors increase levels; inducers reduce levels
- Nephrotoxic agents (additive)
New Zealand Prescribing Information
Tacrolimus oral (Prograf® capsules; Astagraf XL® extended-release capsules) are funded by Pharmac under Special Authority for organ transplantation. Topical Protopic® 0.03% ointment (for children 2–15 years) and 0.1% (for adults) are also funded under Special Authority for severe atopic eczema where topical corticosteroids have failed or are not appropriate.
Frequently Asked Questions
Is tacrolimus safer than ciclosporin for transplantation?
Tacrolimus and ciclosporin are both calcineurin inhibitors with similar efficacy and nephrotoxicity profiles. Tacrolimus causes more tremor, neurotoxicity, and new-onset diabetes, while ciclosporin causes more hirsutism and gingival hyperplasia. The choice is guided by individual patient factors and transplant centre protocols.
Can I use Protopic® cream on my child’s face for eczema?
Protopic® 0.03% ointment is approved in NZ for children aged 2–15 years with moderate-to-severe eczema. Unlike topical corticosteroids, it does not cause skin thinning, making it suitable for sensitive areas like the face and eyelids. It carries a theoretical long-term malignancy concern from pre-clinical data, but real-world evidence over 20+ years has not confirmed this in humans.
⚠️ Disclaimer: This page is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or a qualified health provider. In New Zealand, medication availability and funding may vary — check with Pharmac or your pharmacist for current information.
Reviewed by a Registered Pharmacist NZ
References & Further Information
The following New Zealand and international resources were used to inform this page: