
Tacrolimus


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Advagraf ER contains tacrolimus, which is a powerful immunosuppressant. This type of medicine helps in lowering the activity of your immune system so it does not attack a transplanted organ.
ER in Advagraf ER stands for extended release (formulation that works for a longer duration), and it is available in 4 different strengths with 50 capsules per pack. You can order Advagraf ER from Canada safely with a prescription that you can obtain from a qualified health care provider.
When you take this medicine, it prevents kidney transplant rejection in people who receive an allogeneic kidney transplant, usually in combination with other anti-rejection medicines.
You take these capsules once a day, as part of your complete transplant regimen. Take it regularly so that tacrolimus levels stay steady for over 24 hours. This will keep your kidney safe, reduce the risk of rejection episodes, and support graft survival for a longer duration.
Note: This medicine is not approved for liver transplant prophylaxis in the U.S.
| Generic Name | Tacrolimus |
|---|---|
| Brand Name | Advagraf ER |
| Forms | Oral extended-release capsules |
| Strengths Available | 0.5 mg, 1 mg, 3 mg, 5 mg |
| Packaging | 50 capsules per pack |
| Requires Prescription | Prescription only (Rx) |
| Ships to the U.S. | Yes |
Advagraf ER is used to prevent organ rejection in transplant recipients.
For adults:
For children: Dosing in children is typically based on body weight, and the initial dose may range from 0.075 to 0.2 mg/kg per day.
Maintenance dose: Once the transplant has stabilized, the dose is typically reduced to the maintenance dose of 3 to 5 mg daily.
To correctly use Advagraf ER, follow these guidelines:
Advagraf ER contains tacrolimus, a calcineurin inhibitor. Calcineurin is an enzyme inside certain immune cells (T-cells) that helps turn on genes for powerful immune signals, including interleukin-2 (IL-2). IL-2 is one of the key “go” signals that tell T-cells to multiply and attack.
Tacrolimus first binds to an inside cell protein called FKBP-12. This tacrolimus–FKBP-12 complex blocks calcineurin. When calcineurin is blocked, T-cells make less IL-2 and other inflammatory substances, so they are less able to attack the transplanted kidney.
Advagraf ER is an extended-release capsule that gradually releases tacrolimus throughout the day, which further keeps blood levels more stable.
That steady immunosuppression helps protect the graft while reducing big peaks and valleys in drug levels that can contribute to side effects or rejection.
Common Advagraf ER side effects may include:
These side effects are rare, but if any of them occur, contact your primary caregiver immediately:
Black box warning: Advagraf ER may increase the risk of serious infections and malignancies (including lymphoma and skin cancer) in transplant patients.
Other important warnings:
Take these precautions while using Advagraf ER:
If you forget a dose of Advagraf ER, take the missed dose as soon as you recall within about 14 hours of your usual time, then return to your normal schedule the next day.
But, if more than roughly half a day has passed, skip the dose that you missed and take the next dose at the usual time the following morning.
Taking too much Advagraf ER can raise the levels of tacrolimus in your blood and lead to serious problems like:
Kidney failure
Severe high blood pressure
Dangerous infections
Seizures
Heart rhythm changes
If you think you or someone else has taken an overdose, whether accidentally or on purpose, call your local emergency medical care right away, or contact the Poison Control Center at their number 1-800-222-1222, which is toll-free.
Do not wait for symptoms to appear, and do not try to treat an overdose on your own.
| Drug Category | Examples | Effect or Precaution |
|---|---|---|
| CYP3A4 Inhibitors | Ketoconazole, Itraconazole, Clarithromycin, Ritonavir | Greatly increase the tacrolimus in your blood. Dose reduction and close monitoring are required. |
| CYP3A4 Inducers | Rifampin, Carbamazepine, Phenytoin, St. John’s Wort | Significantly decrease tacrolimus levels, which increases the risk of organ rejection. Avoid co-use or adjust dose. |
| Nephrotoxic Medications | NSAIDs (ibuprofen), Aminoglycosides, Amphotericin B, IV contrast dyes | Additive kidney toxicity. Use alternatives or monitor renal function closely. |
| Potassium-Increasing Drugs | Spironolactone, ACE inhibitors (lisinopril), ARBs (losartan), and Potassium supplements | High potassium risk increases. Monitor potassium levels and avoid unnecessary potassium intake. |
| Other Immunosuppressants | Sirolimus, Everolimus, Cyclosporine | May increase toxicity or alter absorption. Cyclosporine, especially, should NOT be used at the same time. |
| Live Vaccines | MMR, Varicella, Yellow fever | Avoid live vaccines because tacrolimus suppresses the immune system. Vaccines may be ineffective or cause infection. |
| Grapefruit | Grapefruit fruit, juice, extracts | Potently increases tacrolimus blood concentration. Avoid entirely to prevent toxicity. |
| QT-Prolonging Drugs | Ondansetron, Fluoroquinolones (levofloxacin), Amiodarone | Tacrolimus may prolong QT, and combining with QT-prolonging agents raises arrhythmia risk. ECG and electrolyte monitoring advised. |
| Alternative Medication | Active Ingredient | Potency Level | Best For | Form | Key Advantage |
|---|---|---|---|---|---|
| Prograf | Tacrolimus (Immediate-release) | High | Kidney, liver, and heart transplant rejection prevention | Capsule / Oral | Same active drug as Advagraf ER, but offers flexible twice-daily dosing |
| Envarsus XR | Tacrolimus (Extended-release, MeltDose) | High | Kidney transplant maintenance immunosuppression | Tablet (ER) | Improved absorption with lower peak-to-trough variability. Often requires a lower total daily dose |
| Cyclosporine (Neoral, Gengraf, Sandimmune) | Cyclosporine | High | Kidney, liver, and heart transplant rejection prevention | Capsule / Oral solution | Calcineurin inhibitor alternative for patients intolerant to tacrolimus or with tacrolimus-induced nephrotoxicity |
| Rapamune | Sirolimus | Medium | Kidney transplant rejection prevention (often used with lower tacrolimus or after CNIs are reduced) | Tablet / Oral solution | mTOR inhibitor with reduced nephrotoxicity compared to calcineurin inhibitors |
| Everolimus (Zortress) | Everolimus | Medium | Kidney and liver transplant maintenance therapy | Tablet | Lower toxicity alternative; reduces CNI exposure; useful for patients with CNI-related side effects |
| Myfortic / CellCept | Mycophenolic acid / Mycophenolate mofetil | Medium | First-line combo therapy with tacrolimus or cyclosporine in kidney, liver, and heart transplants | Tablet / Capsule | Powerful antiproliferative agent used universally with tacrolimus to reduce rejection risk |
| Azathioprine | Azathioprine | Low–Medium | Alternative immunosuppressant when mycophenolate cannot be used (pregnancy-safe option) | Tablet | Well-tolerated, long history of safety, and safe in pregnancy compared to mycophenolate |
| Belatacept | Belatacept | Medium–High (biologic) | Kidney transplant patients who cannot tolerate CNIs (tacrolimus/cyclosporine) | IV infusion | Calcineurin-inhibitor–free option with better long-term kidney function and lower nephrotoxicity |
| Prednisone | Prednisone | Low (steroid) | Universal adjunct in early post-transplant and rejection treatment | Tablet | Essential for induction and rejection treatment; reduces acute rejection risk when used with CNIs |
At Polar Bear Meds, we’re committed to making prescription medications like Advagraf ER more accessible and affordable for patients in the U.S. Our prices are significantly lower than typical U.S. pharmacy retail rates without compromising on safety or quality. Every order is sourced exclusively from licensed and trusted pharmacies and undergoes complete prescription verification to ensure compliance and authenticity. We offer discreet, trackable shipping to all U.S. states, along with refill support for ongoing treatment. Our friendly customer service team is here to help you.
Get your medicines delivered straight from Canada to your doorstep in the U.S. You can also save more by using the Advagraf ER coupon code “WELCOMEPB10” for 10% off on your first order. There are no hidden handling or processing fees, as we believe in complete transparency. Looking to save even more? Join our referral program & earn a $20 credit every time you refer a friend or a family member. Your referral will also receive a $20 credit, so everyone wins. Additionally, after every 10 verified customers' referrals, you'll receive a $100 credit in your account as a thank-you for spreading the word.
At Polar Bear Meds, your safety is our priority. Every order is dispensed from a fully licensed Canadian pharmacy following strict standards for quality, security, and patient care. To conveniently buy Advagraf ER from Canada at a competitive cost, call us at 1-888-779-2193 toll-free.
The content provided on the Polar Bear Meds website serves to increase knowledge about healthcare products and medical conditions and is strictly for informational purposes. It should not replace professional medical advice. We urge you to consult with a qualified healthcare professional prior to utilizing any prescription or over-the-counter medication. Our platform grants access to an extensive array of products, sourced internationally, including Canada. We collaborates with a licensed pharmacy partner in Canada and trusted dispensing pharmacies globally. All affiliated fulfillment centers are accredited by the regulatory authorities of their respective countries.

Dr. Jackson Miller is a board-certified medicine physician & hospitalist. He is a healthcare professional with a strong background in patient care. With years of experience and a patient-first approach, he believes the foundation of good health is a patient who feels informed and empowered. He contributes to medical content review, drawing on his background in clinical practice and patient education. He focuses on presenting health information in a clear, accurate, and accessible way to help readers make informed decisions. His work emphasizes clarity, evidence-based guidance, and understandable explanations of medical topics.

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