Рефераты. Такролимус

HOW SUPPLIED:

|Prograf capsules (tacrolimus capsules) 0.5 mg |

|Oblong, light yellow, branded with red "0.5 mg" on the capsule cap and "|

|607" on the capsule body, supplied in 60-count bottles (NDC |

|0469-0607-67), containing the equivalent of 0.5 mg anhydrous tacrolimus.|

| |

|Prograf capsules (tacrolimus capsules) 1 mg |

|Oblong, white, branded with red "1 mg" on the capsule cap and " 617" on |

|the capsule body, supplied in 100-count bottles (NDC 0469-0617-71) and |

|10 blister cards of 10 capsules (NDC 0469-0617-10), containing the |

|equivalent of 1 mg anhydrous tacrolimus. |

|Prograf capsules (tacrolimus capsules) 5mg |

|Oblong, grayish/red, branded with white "5 mg" on the capsule cap and " |

|657" on the capsule body, supplied in 100-count bottles (NDC |

|0469-0657-71) and 10 blister cards of 10 capsules (NDC 0469-0657-10), |

|containing the equivalent of 5 mg anhydrous tacrolimus. |

|Store and Dispense |

|Store at 25° C (77° F); excursions permitted to15° C-30° C (59° F-86° |

|F). |

|Prograf injection (tacrolimus injection) 5mg (for IV infusion only) |

|Supplied as a sterile solution in 1 mL ampules containing the equivalent|

|of 5 mg of anhydrous tacrolimus per mL, in boxes of 10 ampules (NDC |

|0469-3016-01). |

|Store and Dispense |

|Store between 5° C and 25° C (41° F and 77° F). |

|Made in Ireland |

|Prograf capsules (tacrolimus capsules) 0.5 mg |

|Oblong, light yellow, branded with red "0.5 mg" on the capsule cap and "|

|607" on the capsule body, supplied in 100-count plastic bottles (NDC |

|0469-0607-73) containing the equivalent of 0.5 mg anhydrous tacrolimus. |

|Prograf capsules (tacrolimus capsules) 1 mg |

|Oblong, white, branded with red "1 mg" on the capsule cap and " 617" on |

|the capsule body, supplied in 100-count plastic bottles (NDC |

|0469-0617-73) and 10 blister cards of 10 capsules (NDC 0469-0617-11), |

|containing the equivalent of 1 mg anhydrous tacrolimus. |

|Prograf capsules (tacrolimus capsules) 5mg |

|Oblong, grayish/red, branded with white "5 mg" on the capsule cap and " |

|657" on the capsule body, supplied in 100-count plastic bottles (NDC |

|0469-0657-73) and 10 blister cards of 10 capsules (NDC 0469-0657-11), |

|containing the equivalent of 5 mg anhydrous tacrolimus |

|Store and Dispense |

|Store at 25°C (77°F); excursions permitted to 15°C-30°C (59°F-86°F). |

|Made in Japan |

Manufactured for:

Fujisawa Healthcare, Inc.

Deerfield, IL 60015-2548

Rx only

ZL40305/06

REFERENCE

1. CDC: Recommendations of the Advisory Committee on Immunization

Practices: Use of vaccines and immune globulins in persons with altered

immunocompetence. MMWR 1993;42(RR-4):1-18.

http://www.fujisawa.com/medinfo/pi/pi_main_pg.htm

GENERIC NAME: tacrolimus

BRAND NAME: Prograf

DRUG CLASS AND MECHANISM: Tacrolimus is a drug that suppresses the immune

system and is used to prevent rejection of transplanted organs. Tacrolimus

accomplishes its immune-suppressing effecting by inhibiting an enzyme

(calcineurin) crucial for the multiplication of T-cells, cells that are

vital to the immune process. The use of oral tacrolimus allows

transplantation specialists to reduce the dose of steroids which are also

used to prevent rejection. This "steroid-sparing effect" is important

because of the many side effects that can occur when larger doses of

steroids are used for a long period of time. Tacrolimus was approved by the

FDA in April, 1994 for liver transplantation and also has been used in

patients for heart, kidney, small bowel, and bone marrow transplantation.

GENERIC AVAILABLE: No

PRESCRIPTION: Yes

PREPARATIONS: Tacrolimus is available as 1mg and 5mg capsules. It also is

available for intravenous use.

STORAGE: Tacrolimus should be stored at room temperature between 15° and

30°C (59° and 86°F).

PRESCRIBED FOR: Tacrolimus is used for the prevention of rejection of

transplanted organs.

DOSING: Oral tacrolimus is taken twice daily. Doses vary widely and are

based on blood tests that measure the amount of tacrolimus in the body.

Taking tacrolimus with food can reduce some of the abdominal pain that can

occur with this medicine; however, food can reduce the amount of tacrolimus

that is absorbed. This is especially true with fatty foods. Thus,

tacrolimus is best taken without food. If it must be taken with food, it

should be taken with non-fatty food.

DRUG INTERACTIONS: The destruction of tacrolimus by the body may be

inhibited by a large number of drugs, resulting in higher blood levels of

tacrolimus, and possibly increasing its side effects. Such drugs include

bromocriptine (Parlodel), cimetidine (Tagamet), cisapride (Propulsid),

clarithromycin (Biaxin), cyclosporine (Sandimmune; Neoral), danazol

(Danacrine), diltiazem (Cardizem; Tiazac), erythromycin, fluconazole

(Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), metoclopramide

(Reglan), methylprednisolone (Medrol), nicardipine (Cardene),

troleandomycin (Tao), and verapamil (Calan; Isoptin; Verelan; Covera-HS).

Grapefruit juice also may have a similar effect on tacrolimus and should be

avoided.

Other drugs can stimulate the break-down of tacrolimus, decreasing its

blood concentration and possibly reducing its effectiveness. Such drugs

include carbamazepine (Tegretol), nifedipine (Procardia; Adalat);

phenobarbital, phenytoin (Dilantin), rifabutin, and rifampin,

tacrolimus

Live virus vaccines should be avoided while receiving tacrolimus or any

other medicine that suppresses the immune system since the vaccines may be

less effective.

Since tacrolimus can cause hyperkalemia (high potassium in the blood), the

use of tacrolimus with diuretics that also cause retention of potassium is

not recommended. Such diuretics include triamterene (found in Dyazide and

Maxzide), amiloride (found in Moduretic), and spironolactone (Aldactone).

Aluminum hydroxide, which is found in many antacids, binds tacrolimus in

the stomach. Aluminum-containing antacids should not be taken with

tacrolimus.

PREGNANCY: Tacrolimus crosses the placenta, but there have been no adequate

studies in pregnant women to assess the effects on the fetus. Among women

who have received tacrolimus while pregnant, high potassium levels and

kidney injury in newborns have been reported. Therefore, tacrolimus should

be used during pregnancy only when it is clearly needed.

NURSING MOTHERS: Tacrolimus passes into breast milk. It is recommended that

breast-feeding be discontinued while women are receiving oral tacrolimus.

SIDE EFFECTS: Tacrolimus is associated with many and various side effects.

These include baldness (which can occur in 1 in 5 patients who take it),

anemia (1 in 2), loss of appetite (1 in 3), diarrhea (3 of 4), high

concentrations of potassium in the blood (1 in 2), high blood presure (1 in

2), nausea (1 in 2), vomiting (1 in 4), tingling sensation in the

extremities (2 in 5), itching (1 in 3), tremor (1 in 2), fever (1 in 2),

headache (2 in 3), rash (1 in 4), high blood sugar concentrations (between

1 in 3 and 1 in 2), and abdominal pain (1in 4).

Other side effects may include confusion, painful joints, increased

sensitivity to light, blurred vision, insomnia, infection, jaundice

(yellowing of the skin due to effects on the liver), kidney injury, swollen

ankles, and seizures.

PROGRAF (tacrolimus) Capsules and Injection

July 25, 2001: Fujisawa

Revisions to the PRECAUTIONS and ADVERSE REACTIONS sections. A new

Patient’s Information leaflet is added to the PROGRAF Capsules labeling

PRECAUTIONS

*Drugs That May Decrease Tacrolimus Blood Concentrations:

Anticonvulsants Antibiotics

carbamazepine rifabutin

phenobarbital rifampin

phenytoin

Herbal Preparations

St. John’s Wort

*This table is not all inclusive.

St. John’s Wort (hypericum perforatum) induces CYP3A4 and P-glycoprotein.

Since tacrolimus is a substrate for CYP3A4, there is the potential that the

use of St. John’s Wort in patients receiving Prograf could result in

reduced tacrolimus levels.

ADVERSE REACTIONS

Post Marketing

The following have been reported: increased amylase including pancreatitis,

hearing loss including deafness, leukoencephalopathy, thrombocytopenic

purpura, hemolytic-uremic syndrome, acute renal failure, Stevens-Johnson

syndrome, stomach ulcer, glycosuria, and cardiac arrhythmia and

gastroenteritis.

Patient Information

PROGRAF

(tacrolimus capsules)

Read this important information before you start using PROGRAF [PRO-graf]

and each time you refill your prescription. This summary does not take the

place of talking with your transplant team.

Talk with your transplant team if you have any questions or want more

information about PROGRAF. You can also visit the Fujisawa Internet site at

www.fujisawa.com.

What Is PROGRAF?

PROGRAF is a medicine that slows down the body’s immune system. For this

reason, it works as an anti-rejection medicine.

PROGRAF helps patients who have had a liver or kidney transplant protect

their new organ and prevent it from being rejected by the body.

How Does PROGRAF Protect My New Organ?

The body’s immune system protects the body against anything that it does

not recognize as part of the body. For example, when the immune system

detects a virus or bacteria it tries to get rid of it to prevent infection.

When a person has a liver or kidney transplant, the immune system does not

recognize the new organ as a part of the body and tries to get rid of it,

too. This is called "rejection." PROGRAF protects your new organ by slowing

down the body’s immune system.

Who Should Not Take PROGRAF?

Do not take PROGRAF if you are allergic to any of the ingredients in

PROGRAF. The active ingredient is tacrolimus. Ask your doctor or pharmacist

about the inactive ingredients.

Tell your transplant team about all your health conditions, including

kidney and/or liver problems. Discuss with your transplant team the use of

any other prescription and non- prescription medications, including any

herbal or over-the-counter remedies that you may take while on Prograf. In

very rare cases you may not be able to take Prograf.

Tell your transplant team if you are pregnant, planning to have a baby or

are breastfeeding. Talk with your transplant doctor about possible effects

PROGRAF could have on your child. Do not nurse a baby while taking PROGRAF

since the medicine will be in the breast milk.

How Should I Take PROGRAF?

PROGRAF can protect your new kidney or liver only if you take the medicine

correctly.

Your new organ needs around-the-clock protection so your body does not

reject it. The success of your transplant depends a great deal upon how

well you help PROGRAF do its job. Here is what you can do to help.

Take PROGRAF exactly as prescribed

It is important to take PROGRAF capsules exactly as your transplant team

tells you to.

PROGRAF comes in several different strength capsules--0.5 mg, 1 mg and 5

mg. Your transplant team will tell you what dose to take and how often to

take it. Your transplant team may adjust your dose until they find what

works best for you.

Never change your dose on your own. Never stop taking PROGRAF even if you

are feeling well. However, if you feel poorly on Prograf, discuss this with

your transplant team.

Take PROGRAF two times a day, 12 hours apart

Try to pick times that will be easy for you. For example, if you take your

first dose at 7:00 a.m. you should take your second dose at 7:00 p.m. Do

not vary the times. You must take PROGRAF at the same times every day. If

you decide to take PROGRAF at 7:00 a.m. and 7:00 p.m., take it at these

same times every day. This will make sure you always have enough medicine

in your body to give your new organ the around-the-clock protection it

needs.

Take PROGRAF the same way each day

Some people prefer to take PROGRAF with food to help reduce possible

stomach upset. Whether you take PROGRAF with or without food, it is

important to take PROGRAF the same way every day. For example, if you take

PROGRAF with food, you should always take it with food. Do not eat

grapefruit or drink grapefruit juice in combination with your medicine

unless your transplant teams approves. Do not change the way you take this

medicine without telling

your transplant team, since this could change the amount of protection you

get from PROGRAF.

Take all your doses

It is important to take your doses twice a day exactly as prescribed by

your doctor. If you miss even two doses, your new liver or kidney could

lose the protection it needs to defend itself against rejection by your

body.

If you miss one dose, do not try to catch up on your own. Call your

transplant team right away for instructions on what to do.

If you travel and change time zones, be sure to ask your transplant team

how to adjust your dosage schedule so your new organ does not lose its

protection.

Plan ahead so that you do not run out of PROGRAF

Make sure you have your prescription for PROGRAF refilled and at home

before you need it. Circle the date on a calendar when you need to order

your refill. Allow extra time if you receive your medicines through the

mail.

Your transplant team will follow your progress and watch for early signs of

side effects. This is why you will have blood tests done often after your

transplant. On the days you are going to have a blood test to measure the

amount of PROGRAF in your body, your transplant team may ask you not to

take your morning dose until after the blood sample is taken. Check with

your transplant team before skipping this dose.

Can Other Medicines Affect How PROGRAF Works?

Some medicines and alcohol can affect how well PROGRAF works. After you

start taking PROGRAF:

Be sure to tell your transplant team, family doctor, dentist, pharmacist

and any other health care professional treating you the names of all the

medicines you are taking. This includes PROGRAF as well as all other

prescription medicines and non- prescription medicines, natural or herbal

remedies, nutritional supplements, and vitamins. This is the only way that

your health care team can help prevent drug interactions that could be

serious.

Always check with your transplant team before you start taking any new

medicine.

While you are taking PROGRAF, do not get any vaccinations without your

transplant team’s approval. The vaccination may not work as well as it

should.

Liver transplant patients, including those taking PROGRAF, should not drink

alcohol.

What Are the Possible Side Effects of PROGRAF?

Tell your transplant team right away if you think you might be having a

side effect. Your transplant team will decide if it is a medicine side

effect or a sign that has nothing to do with the medicine but needs to be

treated. Infection or reduced urine can be signs of serious problems that

you should discuss with your transplant team.

Your transplant team will also follow your progress and watch for the early

signs of any side effects. This is why you will have blood tests done often

during the first few months after your transplant. On the days you are

going to have a blood test to measure the amount of PROGRAF in your body,

your transplant team may ask you not to take your morning dose until after

the blood sample is taken. Check skipping this dose.

For Kidney Transplant Patients:

The most common side effects of PROGRAF for kidney transplant patients are

infection, headache, tremors (shaking of the body), diarrhea, constipation,

nausea, high blood pressure, changes in the amount of urine, and trouble

sleeping.

Less common side effects are abdominal pain (stomach pain), numbness or

tingling in your hands or feet; loss of appetite; indigestion or "upset

stomach"; vomiting; urinary tract infections; fever; pain; swelling of the

hands, ankles or legs; shortness of breath or trouble breathing; cough; leg

cramps; heart "fluttering", palpitations or chest pain; unusual weakness or

tiredness; dizziness; confusion; changes in mood or emotions; itchy skin,

skin rash, and diabetes.

For Liver Transplant Patients:

The most common side effects of PROGRAF for liver transplant patients are

headache, tremors (shaking of the body), diarrhea, high blood pressure,

nausea and changes in the amount of urine.

Less common side effects are numbness or tingling in your hands or feet;

trouble sleeping; constipation; loss of appetite; vomiting; urinary tract

infections; fever; pain (especially in the back or abdomen [stomach area]);

swelling of the hands, ankles, legs or abdomen; shortness of breath or

trouble breathing; cough; unusual bruising; leg cramps; heart "fluttering"

or palpitations; unusual weakness or tiredness; confusion; changes in mood

or emotions; itchy skin, and skin rash.

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