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Astagraf XL
Tacrolimus
$146.00
0.5mg · 2 × 50 capsules · 3 months supply
BrandBranded medicine· By Astellas
$48.67 per month
Strength
How long a supply?
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Annual cost
$511a year at this pack size
Prescription required
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0.5mg
1 MG
3mg
5mg
FDA boxed warningMalignancies and serious infections in transplant patients; and increased mortality in female liver transplant patients
Increased risk for developing serious infections and malignancies with ASTAGRAF XL ® or other immunosuppressants that may lead to hospitalization or death.
Increased mortality in female liver transplant patients with ASTAGRAF XL. ASTAGRAF XL is not approved for use in liver transplantation.
Increased mortality in female liver transplant patients with ASTAGRAF XL. Not approved for use in liver transplantation.
About Astagraf XL
Overview
Astagraf XL contains tacrolimus, an immunosuppressant, in extended-release capsules. It is used with other immunosuppressants to help prevent organ rejection after a kidney transplant in adults and children who can swallow capsules whole. It works by blocking calcineurin, an enzyme involved in activating immune cells, which reduces immune system activity.
What it treats
- Prevention of organ rejection after a kidney transplant, used with other immunosuppressants in adults and children who can swallow capsules whole.
Safety information
Side effects
Common side effects include diarrhea, constipation, nausea, swelling in the hands or feet, tremor and anemia (a low red blood cell count). Contact your doctor promptly about serious side effects. These include serious infections; lymphoma and other cancers; new diabetes after transplant; kidney damage; nervous system problems, including posterior reversible encephalopathy syndrome (PRES); high potassium; high blood pressure; and QT prolongation, a change in the heart’s electrical activity. Serious blood disorders include pure red cell aplasia, in which the body does not make enough red blood cells, and thrombotic microangiopathy, involving blood clots in small blood vessels. The label also warns of an increased risk of death in female liver transplant patients.
FDA boxed warning
Malignancies and serious infections in transplant patients; and increased mortality in female liver transplant patients
Increased risk for developing serious infections and malignancies with ASTAGRAF XL ® or other immunosuppressants that may lead to hospitalization or death.
Increased mortality in female liver transplant patients with ASTAGRAF XL. ASTAGRAF XL is not approved for use in liver transplantation.
Increased mortality in female liver transplant patients with ASTAGRAF XL. Not approved for use in liver transplantation.
A boxed warning is the strongest warning the US Food and Drug Administration requires on a medicine label. Text is taken from the official label, with internal section references removed.
Before taking this medicine
Do not take Astagraf XL if you have a known allergy to tacrolimus. Astagraf XL can cause harm to an unborn baby. If you are pregnant, discuss this risk with your prescriber. Caution and monitoring are needed because Astagraf XL may cause new-onset diabetes after transplant, kidney damage, nervous system problems, high potassium levels, high blood pressure and heart rhythm changes (QT prolongation). Other medicines may increase the risk of kidney damage or high potassium. People at high risk of QT prolongation may need an ECG and electrolyte monitoring. Other serious risks include pure red cell aplasia, a condition in which the body does not make enough red blood cells, and thrombotic microangiopathy, which involves blood clots in small blood vessels. The latter may be more likely with infections or certain other medicines. Avoid live vaccines during treatment. Astagraf XL is not interchangeable with other tacrolimus products. Make sure you or your caregiver can recognise your Astagraf XL capsules to help prevent medication errors.
Interactions
Tell your doctor if you take cannabidiol or medicines that strongly affect CYP3A, an enzyme involved in processing tacrolimus. Strong CYP3A inducers can increase the risk of transplant rejection, while strong CYP3A inhibitors can increase the risk of serious side effects. Your doctor will need to monitor tacrolimus blood levels and may adjust your treatment. When cannabidiol is taken with Astagraf XL, your doctor should consider monitoring tacrolimus blood levels and reducing your prescribed dose.
Using Astagraf XL
Dosing
Dosing is set by your prescriber. Each health care professional may prescribe medication differently according to a patient's medical history and condition, so follow the directions on your prescription label and speak to your doctor or pharmacist before changing anything.
Storage
Store below 25°C in a dry place, in the original pack, away from direct light and moisture. Do not keep it in a bathroom. Keep all medicines out of the sight and reach of children.
Clinical information on this page is summarised from the US FDA label ASTAGRAF XL (TACROLIMUS EXTENDED-RELEASE CAPSULES) CAPSULE, COATED, EXTENDED RELEASE [ASTELLAS PHARMA US, INC.] (DailyMed, retrieved 19 September 2026).
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