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

Key takeaways

Azathioprine (Imuran) and tacrolimus (Prograf, Envarsus XR) are both immunosuppressants used to prevent organ rejection after transplants, but they have some key differences. Azathioprine is also used for rheumatoid arthritis, while tacrolimus is not. Tacrolimus is available in both immediate-release and extended-release forms, whereas azathioprine is only available in immediate-release form. Tacrolimus is typically taken once or twice daily, while azathioprine's dosing can vary based on your condition and weight. Azathioprine has a higher risk of causing skin cancer with long-term use, while tacrolimus can cause nerve problems and high blood pressure. Both medications require regular blood tests to monitor for side effects, but tacrolimus has more interactions with other medications and foods, such as grapefruit juice. Additionally, tacrolimus can cause serious heart and kidney problems, which are less commonly associated with azathioprine.

Imuran

(azathioprine)

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Tacrolimus

(Prograf)

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Summary for Imuran

Prescription only

Imuran (azathioprine) is a medication used after kidney transplantation and also for rheumatoid arthritis. It's not a first choice medication because of many side effects. Your provider may also use Imuran (azathioprine) for other indications as well, although these are off-label (not FDA-approved) uses.

Indications for Imuran

To prevent the body from rejecting a transplanted kidney
Rheumatoid arthritis

Pros and Cons for Imuran

Pros

Works well for the treatment of rheumatoid arthritis, although it's not commonly used unless other medications don't work
Lowers the pain, stiffness, and swelling caused by rheumatoid arthritis
Available in a generic form which is more affordable
Can be used in people who have had a kidney transplant and are planning to become pregnant

Cons

Regular blood tests are required
Raises risk of getting an infection
Not a first choice medication because of many side effects

Common Side Effects for Imuran

Nausea
Vomiting
Leukopenia (lowering of white blood cells in the body)
Infections

Warnings for Imuran

Cancer
Fewer Blood Cells
Greater Risk for Infections
Liver Damage

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