Envarsus XR vs. Prograf for Organ Transplant: Important Differences and Potential Risks.

Envarsus XR

(tacrolimus)

Tacrolimus

(Prograf)

Summary for Envarsus XR

Prescription only

Envarsus XR is a once-daily version of the common anti-rejection medication, tacrolimus. It's an immunosuppressant that's used to prevent organ rejection in adults after they've had a kidney transplant. Envarsus XR (tacrolimus) is an extended-release tablet that's taken by mouth. Side effects can include risk of infection, diarrhea, and shaky hands. Envarsus XR (tacrolimus) is available as a brand-name medication only; there's currently no generic version yet.

Indications for Envarsus XR

Prevention of kidney transplant rejection (in combination with other immunosuppressants)

Pros and Cons for Envarsus XR

Pros

Taken once daily
Thought to help tacrolimus levels be more stable throughout the day
Adjustable dosing based on blood levels of tacrolimus, which can help lessen risk of side effects

Cons

Only approved for use after kidney transplant (not for lung, liver, or heart transplant)
Must get regular blood work done to check that your Envarsus XR (tacrolimus) dose is appropriate and safe for you
Risk of serious infections

Common Side Effects for Envarsus XR

Infection (up to 70%)
Diarrhea (31%)
Anemia (26%)
High blood pressure (23%)
Tremor (shakiness, 19%)
Constipation (18%)
Diabetes (16%)
Swelling in the arms and legs (16%)

Warnings for Envarsus XR

Possible risk of cancer
Serious infections
High blood sugar
Kidney problems and high potassium levels
Problems affecting the nervous system
High blood pressure
Heart rhythm problem called QT prolongation
Blood problems
Interaction with vaccines
Interaction with other medications
Risk for fertility problems and harm to unborn baby

Summary for Prograf

Prescription only

Tacrolimus (Prograf) is a medication used to prevent organ rejection after an organ transplant. The immediate-release (IR) capsules are available as a lower-cost generic medication, whereas the IR granules (Prograf) and extended-release (ER) capsules (Astagraf XL) are only available as brand-name medications. Tacrolimus (Prograf) is taken by mouth, typically twice daily. Your provider will check your tacrolimus level through blood work and adjust your dose if needed. Common side effects of tacrolimus (Prograf) include tremors, headache, diarrhea, and nausea.

Indications for Prograf

Prevention of organ transplant rejection, including:

Kidney transplant
Liver or heart transplant - generic tacrolimus capsule and brand name Prograf only
Lung transplant - brand name Prograf only

Pros and Cons for Prograf

Pros

Available in short-acting and long-acting forms, so there's an option to take once or twice daily
Available as granules to mix into a solution (Prograf), so it's convenient for people who have trouble swallowing
Can be used to prevent organ rejection after different types of transplant
Less likely to cause high cholesterol levels compared to other transplant medications

Cons

Interacts with many medications, such as phenytoin (Dilantin) and omeprazole (Prilosec)
Need to get regular blood work to check for appropriate dose and side effects
Risk of serious infections
Can cause side effects such as tremor, headache, and diarrhea

Common Side Effects for Prograf

Tremor (54%)
High blood pressure (50%)
Changes in electrolyte levels (up to 49%)
Infections (up to 45%)
Higher creatinine levels (45%)
Headache (44%)
Diarrhea (44%)
Nausea (38%)
Swelling of hands and feet (36%)
Constipation (35%)
Feeling weak (34%)
General pain (up to 33%)
Trouble sleeping (32%)
Low red blood cell count (30%)

Warnings for Prograf

Possible risk of skin or lymph node cancer
Serious infections
Higher risk of death in females taking Astagraf XL after liver transplant (not an FDA-approved use)
High blood sugar
Kidney problems
Nerve or brain problems
High blood pressure
Heart problems
Blood problems
Harm to unborn babies and lower sperm count
Interaction with vaccines
Interaction with other medications