Although there was not a significant improvement in survival, tacrolimus has been approved for primary immunosuppression in liver allograft recipients. Treatment with tacrolimus begins 6 hours after transplant surgery. Usually a continuous infusion will be given. Tacrolimus is incompatible with PVC, so tubing and syringes containing such plastics should not be used. Once the patient can swallow, the capsules are given twice a day.
Absorption is erratic and is reduced by food.
Tacrolimus is highly bound to red blood cells and plasma proteins. The half-life varies between 3.5 and 40.5 hours with most of the drug being metabolised in the liver. Although tacrolimus and cyclosporin appear to have similar adverse effects, they are more likely to develop in patients given tacrolimus. The most common complaints are diarrhoea, headache, tremor and nausea. Glucose metabolism and renal function may be impaired.