Tacrolimus works by blocking the production of cells that attack the new kidney and cause rejection.
There are different brands of Tacrolimus, for example 'Adoport' and it is very important that you remain on the same brand. You must not switch between brands unless your consultant tells you to.
Tacrolimus is usually a twice daily medication taken 12 hours apart and on an empty stomach (you should not eat for at least 2 hours before and one hour after taking tacrolimus). In your medication counselling appointment, the pharmacist will work with you to get a regime that suits your daily routine. Until your appointment with the transplant pharmacist, please take your Adoport at 10:00 and 22:00.
Adoport capsules should be swallowed whole with a glass of water. The kidney transplant team will advise you on the dose you need to take. If you are uncertain about what to do, contact the kidney transplant team for advice.
Regular blood tests will be required initially after your transplant in order to check the Tacrolimus level in your blood. This is to ensure an optimum dose with minimum side effects. When attending clinic, do not take your morning dose of Tacrolimus and bring the dose with you to hospital so it can be taken after your blood test.
The night before your transplant appointments you will need to adjust the time you take your Adoport as I explained. On the day of your appointment, you should not take your Adoport until immediately after your blood test. This will give us an accurate 12-hour blood test to work from and improve how we manage your transplant
Your dose of Tacrolimus may be altered according to the blood results. If this is necessary you will be contacted by telephone.
How to get more supply
This will be supplied by the hospital going forward. Please ensure you always have two weeks supply spare at home for emergencies. When you require more please tell your kidney transplant team at your clinic appointment. Should you be running short between clinic appointments, contact the kidney transplant pharmacist and leave a voicemail:
On Saturdays and Sundays, please contact the Renal Admission Unit (RAU):
Side effects
- Tremor (shaking) of the hands
- Numb, hot or tingly hands, feet or mouth (often self resolves within the first month)
- Diabetes
- High blood pressure
- Altered kidney function - this will constantly be monitored in transplant clinic
- Skin cancer - very rare
You may experience some of these side effects. Tell your kidney transplant team if you do, there is often a solution. Your blood pressure, blood sugars and kidney function will be checked in clinic and changes can be made if necessary.
Taking other medicines with Tacrolimus
Some medicines can increase or decrease your tacrolimus level in the blood. This may increase your chance of side effects or rejection. Always check with the prescriber if your medications are safe with tacrolimus. If you are uncertain contact your kidney transplant team before taking any prescribed medicines or any new over the counter medicines or herbal remedies.
Medicines you should avoid while taking Tacrolimus
- Some antibiotics called erythromycin and clarithromycin
- Non-steroidal anti-inflammatory drugs such as ibuprofen or diclofenac (can affect your kidney)
- Some antifungals e.g. fluconazole
- St Johns Wort
Dietary restrictions with Tacrolimus
Certain fruits and vegetables can interact with transplant medications and as a consequence may increase the risk of toxicity or rejection. I have asked you to avoid the following foods and herbal supplements.
- Grapefruit and grapefruit juice (please note that some citrus-flavored drinks have a grapefruit extract in them, so it is important to check ingredient lists)
- Pomegranate and pomegranate juice
- Seville Oranges and Orange marmalade (normal oranges are fine in moderation)
- Vitamin C supplements
- Papaya
- Grapes (in large quantities)
- St. John’s Wort
- Herbal teas: green tea, chamomile, peppermint, dandelion
- Echinacea
- Ginseng
- Feverfew
- Lavender oil supplements
- Tumeric supplements
Skin cancer
Taking Tacrolimus for a long time can increase your chance of getting certain types of cancer, including skin cancer. Though this is very rare, we would advise avoiding strong sunlight, using sunscreen (SPF 50 or more) and that you wear clothes that cover your arms and legs when out in sunlight, even on cloudy days.
What to do if you forget to take your dose of Tacrolimus
A missed dose of tacrolimus should be taken at least six hours before the next dose is due. If there is less than six hours do not take that missed dose and carry on with the next dose at the normal time. Never double dose to make up for missed doses.
What do I do if I vomit after I have had a dose of Tacrolimus?
If you vomit within 30 minutes of taking tacrolimus, repeat the same dose again. If you vomit 30 minutes after taking tacrolimus do not repeat the dose and wait until the next normal dose is due.
If you continue to vomit or you are concerned you are unwell please contact the kidney transplant team.
Last reviewed: 24 March 2026