Tacrolimus is an active ingredient belonging to the class of immunosuppressants, which subsequently works by suppressing the actions of immune cells and the immune system of the body. It is useful in situations where the body rejects new organs like lungs, liver, or kidneys after an organ transplant. Prograf 1mg capsule is a brand that contains the active compound tacrolimus that delivers a therapeutic effect.

Indications:

1. Prevention of organ rejection in recipients of allogeneic heart, kidney, or liver transplants
2. It can be used along with adrenal corticosteroids in prophylactic treatment approaches in kidney, liver, and lung transplants.

Mechanisms involved in preventing organ rejection:

Tacrolimus acts through a cascade of events that involve effective immune suppression. An enzyme called calcineurin is involved in the activation of T cells which is essential for producing basic immune responses against the inflammations. Tacrolimus blocks and inhibits the activity of this enzyme calcineurin thus preventing the activation of T cells.

The next tacrolimus interferes with the regular signal transduction process of the T cells, to be particular it prevents the nuclear factor of the activated T cells [NFAT] from being dephosphorylated. This reaction causes the stoppage of NFAT from binding to the nucleus of the cells and turning on the immune response.

After the successful blockage of NFAT and cutting down the further process, tacrolimus is also directly involved in reducing the production of pro-inflammatory cytokines which is produced by macrophages in response to inflammatory reactions. This mainly includes a reduced number of interleukin-2 and major cytokines. The reduced and decline curve of interleukin 2 makes the immune system shut down.

By this complex process, tacrolimus prograf suppresses the immune action and ensures a suppressed immune system does not attack any foreign invaders, including the transplanted organ. Thus, a successful organ acceptance is done under the action of tacrolimus prograf.

Side effects of tacrolimus prograf:

1. Increased risk of infection: As a result of immunosuppression our body becomes more prone and susceptible to various infections which can be life-threatening on progression without treatment.
2. Increased risk of developing cancers: this drug is associated with the development of various skin, lymph node, and gland cancer (lymphoma)
3. Nervous system-related adverse effects: Tremor, Headache, Insomnia.
4. Gastrointestinal side effects: Diarrhea, nausea, constipation
5. Cardiovascular-related events: Hypertension, chest pain
6. Skin-related issues: Rashes, Pruritus
7. Metabolic and nutritional issues: Hypophosphatemia, Hypomagnesemia, Hyperlipidemia, Hyperkalemia, Hyperglycemia
8. Musculoskeletal side effect: Arthralgia
9. Respiratory system: Dyspnea, increased cough
10. Incidence of developing diabetes mellitus may be increased after the intake of tacrolimus.

Contraindications:

Patients who are allergic to or having known hypersensitivity to tacrolimus and its substitutes should not consume this product. Since tacrolimus prograf suppresses the immune system, individuals with pre-existing infections must not take this product. Vaccination plans, including live vaccines such as MMR and varicella, must be avoided during the treatment plan.

Since tacrolimus prograf is metabolized and eliminated by the liver and kidney respectively any impairment in these organs is not preferred in initiating the therapy.

Note to the patients:

As tacrolimus has a higher incidence of developing skin cancer, protect your skin by avoiding exposure to UV rays and always wear sunglass and higher SPF sunscreen. Grapefruit juice consumption must be avoided since it may prolong the action and make the effects worse. This medicine may take 3- 4 months to start working, so do not discontinue or change the course of treatment. It is recommended to drink at least 8- 10 glasses of water to cope up with kidney function.

Conclusion:

Despite having various side effects of immunosuppressants, they prove to be most efficient in managing postoperative organ rejection. However, abiding by the guidelines in managing side effects scrutinizing the patients, and starting personalized therapeutic management based on various contraindicative patient factors is ideal for the success of the treatment.