How much does tacrolimus cost without insurance?

Written by Rebecca Farley | Reviewed by a licensed U.S. pharmacist | Posted June 26, 2020

Tacrolimus, sold under the brand name Prograf in its oral form, is a life-saving, and expensive, drug used to prevent the rejection of new organs after transplants. Tacrolimus works by lowering immune system activity to prevent the body from attacking a transplanted organ. The brand-name drug sells for almost $7.50 per tablet out of pocket. Even the generic version can be exceedingly expensive at U.S. pharmacies; if you have to pay out of pocket, a single tablet averages about $3.50 per tablet.

The good news is generic tacrolimus can be found for as low as $40 at your local U.S. pharmacy using the U.S. Prescription Discount Card.

If getting the brand name version is important to you, you can order Prograf from Pharmacy Checker-accredited international pharmacies for nearly a fourth of the U.S. cash price.

Protopic (a topical formulation of tacrolimus), an everyday treatment for patients suffering from eczema, sells for more than $300 per bottle. Abroad, the medication sells for a little over $50 per bottle, an approximate 80% discount.

What is the difference between topical and oral tacrolimus?

Doctors use tacrolimus capsules after life-saving transplant operations. The medication suppresses the immune system, preventing it from attacking the new, unfamiliar organ inside the patient’s body. Tacrolimus capsules have been in use since 1994, when the FDA first approved the drug. In 2018, the FDA approved an oral suspension of the drug (in which the drug dissolves in water before patients take it) for patients who struggled to swallow pills. Tacrolimus can also be used intravenously during inpatient care.

Tacrolimus topical, the same drug in a different application, is another matter. The cream, which goes directly on the skin, is used to treat eczema, a condition in which the skin easily becomes irritated by everyday bacteria. The FDA approved the topical ointment in 2008 for treatment of eczema.

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Comparing Tacrolimus (Prograf) Prices

Drug Strength Quantity U.S. Average National Retail Price U.S. Prescription Discount Card Price Lowest International Accredited Pharmacy Price Greatest Percentage Savings
Prograf (tacrolimus) 1 mg 120 capsules $897.41 $716.03 $239.98 73%
Tacrolimus (generic) 1 mg 120 capsules $417.26 $39.53 $146.79 90%
Protopic (tacrolimus topical) 30g of 0.03% $338.76 N/A $58.62 83%
Tacrolimus Topical (generic) 30g of 0.03% $237.75 N/A $50.94 79%

Sources: Average U.S. Retail Price calculated based on pricing on PharmacyChecker U.S. Discount Card Price based on availability at pharmacies near New Orleans, Louisiana. Lowest Accredited International Pharmacy Price based on prices listed on

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What are the side effects of tacrolimus?

Both usages of tacrolimus have drastic, sometimes prohibitive side effects.

Oral Tacrolimus Side Effects

The capsule formulation of tacrolimus can result in the following:

  • Infection
  • Tremor
  • Hypertension
  • Abnormal renal function
  • Constipation
  • Diarrhea
  • Headache
  • Abdominal pain
  • Insomnia
  • Nausea

Topical Tacrolimus Side Effects

The topical tacrolimus can cause a burning of the face that may result in cessation of the prescription. In 2017, the dermatology journal ActaDV published a study that sought to find the source of this side effect. The study points out: “...the main obstacle to use of topical tacrolimus is its local side-effect, a burning sensation, which sometimes leads to discontinuation of treatment.” Additional side effects, according to the FDA, include:

  • Acne
  • Swollen or infected hair follicles
  • Headache
  • Increased sensitivity of the skin to hot or cold temperatures
  • Flu-like symptoms (common cold and stuffy nose, skin tingling, upset stomach, muscle pain, swollen glands)
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What is the difference between tacrolimus 0.1% and 0.03%?

The lower dosage of tacrolimus can be used for children ages 2 - 16 and adults. The lower or higher concentration can be used for patients over the age of 16.

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Is there a generic form of Protopic?

Yes. The Irish pharmaceutical company Perrigo, which specializes in topical prescriptions, manufactures the generic tacrolimus ointment. Fougera, a division of Fougera Pharmaceuticals Inc, Melville, New York is another manufacturer of generic Protopic widely available at U.S. pharmacies.

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What kinds of medication can I take instead of tacrolimus ointment for eczema?

If you wish to cease using Protopic for eczema, you might talk to your doctor about crisaborole (sold under the brand name Eucrisa) or pimecrolimus (Elidel). Both are topical treatments. Eucrisa does not yet have a generic and sells for an average retail price of $782.25. Pimecrolimus is far less expensive; even the brand name version of the drug has an average U.S. retail price of almost half the price of Eucrisa. Elidel (the brand name) sells for an average of $360.96 while pimecrolimus(the trusty generic) has a U.S. average retail price of $217.83.

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Where is tacrolimus manufactured?

Prograf, in its finished formulation, is manufactured in Ireland Ireland, but the main ingredient is a product of Japan. Tacrolimus capsules sold in the U.S. are made in the United States. Protopic sold in the U.S. is manufactured in Ireland.

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