What Is Astagraf XL? Uses, Dosage, and What You Need to Know in 2026

If you or a loved one has received a kidney transplant, your doctor may prescribe Astagraf XL as a cornerstone of your post-transplant medication regimen. This guide explains exactly what Astagraf XL is, what it does, how to take it, and what you need to know to stay safe and healthy in 2026.

What Is Astagraf XL?

Astagraf XL is the brand name for tacrolimus extended-release capsules, manufactured by Astellas Pharma US. It was FDA-approved on July 19, 2013, making it the first once-daily oral tacrolimus formulation approved in the United States. The active ingredient, tacrolimus, has been used for transplant rejection prevention since 1994.

Astagraf XL belongs to a class of drugs called calcineurin inhibitors. It works by suppressing your immune system to prevent your body from rejecting a transplanted kidney, which it would otherwise identify as foreign tissue.

What Is Astagraf XL Used For?

Astagraf XL is FDA-approved for one specific indication:

• Prophylaxis of organ rejection in adult and pediatric kidney transplant patients (who can swallow capsules), in combination with other immunosuppressants

It is used alongside other medications such as mycophenolate mofetil (CellCept) and corticosteroids, with or without basiliximab induction therapy. Important: Astagraf XL is NOT approved for liver transplantation -- it is specifically for kidney transplant patients.

Astagraf XL vs. Prograf: What's the Difference?

Both Astagraf XL and Prograf contain the same active ingredient (tacrolimus), but they work differently:

• Astagraf XL: Extended-release capsules, taken ONCE daily every morning on an empty stomach
• Prograf: Immediate-release capsules, taken TWICE daily (every 12 hours)

The two formulations are NOT interchangeable -- they release tacrolimus at different rates and produce different blood level profiles. Never switch between them without your transplant team's guidance.

How to Take Astagraf XL

Follow these important instructions exactly:

• Take once daily every morning at the same time each day
• Take on an empty stomach -- at least 1 hour before a meal OR at least 2 hours after a meal
• Swallow capsules whole with liquid -- do not chew, divide, crush, or open the capsules
• Avoid grapefruit, grapefruit juice, and alcohol
• If you miss a dose: Take it up to 14 hours after the scheduled time (e.g., missed 8 AM dose: take by 10 PM). Never double up doses.

Dosage Information

Astagraf XL comes in three strengths: 0.5 mg, 1 mg, and 5 mg extended-release capsules. Your starting dose is individualized based on your weight and whether you receive induction therapy:

• With basiliximab induction: 0.15 mg/kg once daily, beginning within 24 hours after transplant
• Without induction: 0.1 mg/kg pre-operatively, then 0.2 mg/kg once daily starting day 2 after transplant

Your dose will be frequently adjusted based on whole blood trough concentrations. The steady state takes approximately 7 days after any dose change. Your transplant team monitors your levels regularly to keep you in the therapeutic range -- enough to prevent rejection, not so much that it causes toxicity.

What Does Astagraf XL Look Like?

Astagraf XL capsules have distinctive appearances that patients should memorize to detect dispensing errors:

• 0.5 mg: Light yellow cap, orange body, branded "647" on body and "0.5 mg" on cap
• 1 mg: White cap, orange body, branded "677" on body and "1 mg" on cap
• 5 mg: Grayish-red cap, orange body, branded "687" on body and "5 mg" on cap

If your dispensed capsules look different from what you normally receive, contact your transplant team before taking them.

Finding and Affording Astagraf XL

Finding Astagraf XL in stock can be challenging since it's brand-only and distributed primarily through specialty pharmacies. medfinder can help you quickly locate a pharmacy with your prescription in stock. For savings options including the Astellas copay card (up to $3,000/year for commercially insured patients), see our guide on how to save money on Astagraf XL.