Pangraf 0.25 Capsule (Tacrolimus 0.25mg)

INTRODUCTION

PANGRAF 0.25MG contains Tacrolimus which belongs to the group of medicines called immunosuppressants. It is used with other medicines to help prevent organ rejection in adults who had a kidney, liver or heart transplant. Following an organ transplant, our immune system will try to reject the newly transplanted organ. Tacrolimus controls our body’s immune response and enables it to accept the transplanted organ.

It may also be given during an ongoing rejection of transplanted liver, kidney, heart or other organ, when previous treatment was unable to control your immune response. Tacrolimus acts by inhibiting the activity of T-lymphocytes and cytokines. While taking this medicine, your doctor might recommend you, to do blood test, urine test, heart and eye tests, to set the correct dose.

It should be taken orally on an empty stomach. Avoid drinking alcohol or grapefruit juice while taking this medicine. Limit your exposure to sun and UV light, because immunosuppressants could increase the risk of skin cancer. PANGRAF 0.25MG must not be taken with cyclosporin. This medicine is not recommended in children and adolescents under 18 years of age.

USES OF PANGRAF 0.25MG

Prophylaxis of organ rejection in adults with kidney, liver or heart transplants

HOW PANGRAF 0.25MG WORKS

Tacrolimus prevents rejection by inhibiting T lymphocyte cells and cytokines, specific cells of the immune system. This in turn controls our body’s immune response and enables it to accept the transplanted organ.

DIRECTIONS FOR USE

Take this medicine on an empty stomach or 2 to 3 hours after a meal or as directed by your physician. Swallow the medicine with a glass of water. Do not crush or chew the medicine. Your doctor will decide the correct dose for you depending upon your condition. Continue to take this medicine, as long as your doctor tells you to do so, to obtain better results.

SIDE EFFECTS OF PANGRAF 0.25MG

COMMON
Diabetes mellitus
Difficulty in sleeping
Headache, dizziness
Increased blood pressure
Stomach pain, diarrhea, mouth ulcers, vomiting, constipation, bloating
Anxiety, confusion, depression, mood changes, hallucination, mental disorders
Fits, tingling and numbness in hands and feet
Blurred vision, ringing in your ears
Faster heartbeat, shortness of breath
Inflammation of pharynx, cough
Yellowing of skin
Muscle pain, back pain, joint pain
Impaired or painful urination
Fever
RARE
Small bleedings in skin due to blood clots
Blindness, deafness
Serious reactions with blistering of skin, mouth, eyes and genitals
Increased hair growth
Feeling thirsty

HOW TO MANAGE SIDE EFFECTS

Vomiting:

Try taking this medicine with, or just after meal. Stick to simple meals. Do not eat rich or spicy food.

Bloating:

Eat smaller and frequent meals. Eat and drink slowly, and exercise regularly. If the symptoms get worse, contact your doctor.

Constipation:

Eat fibre rich foods like fresh fruit, vegetables and cereals. Drink plenty of water. Exercise more regularly.

Diarrhea:

Drink lots of fluids, such as water or juice, to avoid dehydration. Do not take any medicines without speaking to a doctor.

Stomach pain:

Try to rest and relax. You can eat and drink slowly or have smaller and frequent meals. Keeping a heat pad on your stomach may also help. If still pain persists, speak to your doctor.

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WARNING & PRECAUTIONS

PREGNANCY
PANGRAF 0.25MG is not recommended for use in pregnant women unless necessary. Discuss the risks and benefits with your doctor.

BREASTFEEDING
PANGRAF 0.25MG is not recommended for use in breastfeeding women unless necessary. Discuss the risks and benefits with your doctor.

DRIVING AND USING MACHINES
Do not drive or operate any machines if your ability is affected by this medicine.

ALCOHOL
Avoid consumption of alcohol or grape-fruit juice while taking this medicine.

LIVER
PANGRAF 0.25MG should be taken with caution in patients with severe liver disease. Consult your doctor for advice.

ALLERGY
Do not take this medicine if you are allergic (hypersensitive) to tacrolimus, sirolimus, or to any macrolide-antibiotics.

HEART DISEASE
PANGRAF 0.25MG should be taken with caution in patients with QT wave prolongation. Consult your doctor for advice.

OTHERS

Before taking this medicine, inform your doctor if you:

Have severe diarrhea, stomach pain with or without chills, fever, nausea or vomiting, blurred vision or changes in color vision

INTERACTIONS

Talk to your doctor, if you are taking,

Other immunosuppressant drugs (e.g. ciclosporin, mycophenolic acid)
Medicines used to treat viral infections such as HIV (e.g. ritonavir, nelfinavir, saquinavir and cobicistat), hepatitis (telaprevir, boceprevir, ombitasvir, paritaprevir, dasabuvir), human cytomegalovirus (e.g. letermovir), herpes zoaster (e.g. acyclovir)
Macrolide antibiotics (used to treat bacterial infections) e.g. erythromycin, clarithromycin, josamycin, amphotericin B and rifampicin
Antifungal medicines (used to treat fungal infections) e.g. ketoconazole, fluconazole, itraconazole, voriconazole, clotrimazole and isavuconazole
Medicines used to treat stomach ulcer and acid reflux (e.g. omeprazole, lansoprazole or cimetidine)
Medicines used to treat nausea and vomiting (e.g. metoclopramide)
Medicines used to treat heartburn (e.g. cisapride or aluminium-hydroxide)
Medicines used to treat high blood pressure or heart problems (e.g. nifedipine, nicardipine, diltiazem, verapamil, amiodarone)
Medicines used to treat elevated cholesterol and triglycerides (e.g. atorvastatin)
Medicines used to treat depression (e.g. nefazodone, St. John’s Wort, or extracts of Schisandra sphenanthera)
Nilotinib and imatinib (used to treat certain cancers)
Contraceptive pill (birth control pills)
Phenytoin or phenobarbital (used to treat epilepsy)
Corticosteroids (used to treat inflammations) e.g. prednisolone and methylprednisolone
Potassium supplements
Diuretics (used to increase urine output) e.g. amiloride, triamterene, or spironolactone
Non-steroidal anti-inflammatory drugs (NSAIDs, e.g. ibuprofen)
Anticoagulants (used to thin blood) e.g. warfarin, heparin
Oral medicines for diabetes (e.g. metformin)
Vaccinations