Tacrolimus (Topical)

Tacrolimus is an immunosuppressive drug, usually supplied in ointment form for the topical treatment of moderate to severe atopic dermatitis (better known as eczema). It is normally only prescribed to a patient in cases where other drugs have failed to work.

Overview

Eczema is a skin condition caused by the patient's own immune system and exhibits symptoms that include inflammation of the skin, redness, and itching, in much the same way as an allergic reaction.

Tacrolimus works by weakening the immune system of the skin, which will decrease the allergic reaction of the patient, thus relieving atopic dermatitis. Tacrolimus, along with several other drugs, is what is known as a topical calcineurin inhibitor, or a TCI.

Treatment with tacrolimus is not advisable should the patient have a personal history of a specific (and rare) genetic disorder, known as Netherton's syndrome. Furthermore, tacrolimus should never be used by any patient whose immune system is already weakened for whatever reason (immediately after undergoing organ transplantation surgery, for instance.

Tacrolimus is only available if you have a prescription from your doctor.

Tacrolimus is available as the following form of dosage:

  • ointment

Conditions Treated

  • atopic dermatitis (eczema)

Type of Medicine

  • immunosuppressant

Side Effects

Along with its expected and desired effects, tacrolimus might cause some unwanted side effects. While not all of these side effects will necessarily occur, should any of them do so, your may need to seek medical attention or treatment.

Should any of these following side effects occur during your course of tacrolimus, you should check with your doctor or other healthcare professional immediately.

  • yellow eyes and skin
  • weight loss
  • weight gain
  • vomiting
  • unusual weakness or tiredness
  • thick, honey-colored to yellow crusts
  • swollen glands
  • swelling to the figners, hands, lower legs, ankles, or face
  • sudden lack of consciousness
  • stupor
  • spidery blood vessels appearing on the face
  • sores that refuse to heal
  • small, red growths, skin lesions, or bumps, often occurring on arms, hands, neck, ears, hands, and face
  • seizures
  • redness to the face
  • red rash accompanied by pus-filled, watery, or yellow-colored blisters
  • rapid gain of weight
  • new moles
  • nausea
  • twitching of muscles
  • muscle spasms or sudden jerking of the patient's extremities
  • moles that bleed or leak fluids
  • pain to side or lower back
  • unable to control bladder
  • lack of appetite
  • patient begins to look extremely ill
  • lethargy
  • irritability
  • increased thirst
  • increase in blood pressure
  • increased bone pain
  • hostility
  • bumps or growths on skin
  • general unwell feeling
  • fever
  • depression
  • decrease in amount or frequency urination
  • convulsions
  • confusion
  • coma
  • change to color, shape, or size of existing moles
  • stinging or burning sensation to the face
  • bloody urine
  • tarry, black stools
  • agitation

While the above-listed side effects might require medical treatment, there are some side effects that might occur which tend not to need the immediate attention of a doctor. Such effects may disappear during treatment as your body acclimatizes itself to the medication. Also, your doctor may be able to offer advice that will reduce or prevent some of these side effects. Should any of these effects present themselves in a manner that becomes bothersome, check with your doctor.

  • weakness
  • watery eyes
  • wheezing or difficulty breathing
  • tightness in the chest
  • swollen glands
  • swelling to the eyelid, the eyelid's inner lining, or the eye
  • stuffy nose
  • upset or painful stomach
  • sneezing
  • skin tingling
  • flushing of skin whilst consuming alcohol, where the ointment was applied
  • skin burning
  • skin blisters (should only occur is children)
  • severe hives, or skin rash
  • runny nose
  • redness of the eyes
  • rash
  • development pus around hair roots
  • tenderness or pain around the cheekbones and eyes
  • pain to the eyes
  • aches or pains to muscles
  • lack of appetite
  • joint pain
  • itching skin (should only occur in children)
  • itching eyes
  • indigestion
  • increased skin sensitivity
  • skin more sensitive to direct sunlight
  • heartburn
  • headache
  • general pains and aches
  • flushing
  • fever
  • cyst
  • cough
  • chills
  • itching, pain, or burning in areas of the body that are hairy
  • belching
  • back pain
  • acne
  • sour or acid stomach

There may be other side effects which present themselves in some patients. Should you notice any unusual or unwanted effects during your course of tacrolimus, be sure to consult your doctor.

Dosage

Use tacrolimus only as instructed by your prescribing doctor. Using this drug more often, in greater quantities, or for a time period longer than your recommended course of treatment might result in an increased chance of developing side effects.

Tacrolimus will not be the first drug used to treat your eczema. Your doctor will only prescribe it once you have already tried different medications, which have failed to work, or have produced undesired effects.

Tacrolimus might increase your risk of chicken pox, shingles, eczema herpeticum, blisters or blisters on the skin. If you start exhibiting these symptoms, consult your prescribing doctor.

You should not administer tacrolimus continuously over a long period. If your eczema fails to clear, you may need to take a break from medication, before starting a new course on your doctor's advice.

Be sure to read the medication guide that is expected to come with your dosage of tacrolimus. Read the directions carefully, and follow them to the letter, unless your doctor advises otherwise.

Tacrolimus topical ointment is only to be used on the patient's skin. Avoid getting tacrolimus in the mouth, nose, or eyes. It should not be applied to areas of skin that have scrapes or cuts and should be immediately rinsed off, should accidentally application occur.

To use tacrolimus:

Ensure your hands are washed thoroughly with water and soap prior to and following your use of this medication. If the area of skin under treatment is on your hands, avoid washing your hands following the application of tacrolimus.

Before you apply the ointment, be sure to dry your skin entirely.

A narrow layer of tacrolimus should be applied, sufficient to barely cover the affected area of skin, and rubbed in well.

The treated area of skin should not be covered with any kind of wrap, bandage, or dressing.

Immediately following application, you should not swim, bathe, or shower, as the ointment might get washed off.

Should your prescribing doctor recommend the use of moisturizer alongside your course of tacrolimus, you should use it following application of the medicine.

Skin care preparations and cosmetics should not be used on any areas of affected skin.

The amount of tacrolimus prescribed will differ from patient to patient. Be sure to follow the orders of your doctor, or the instructions printed on the label. The information that follows only includes average dosage amounts for this medication. Should you be prescribed a different dosage, you should not amend it unless told to do so by your prescribing doctor.

How much tacrolimus you are prescribed to use will depend upon the drug's strength. The number of dosages you are expected to take, the duration of your course of treatment, and how much time to elapse between applications will all depend upon the exact extent of your condition.

For topical dosage in ointment form

For atopic dermatitis (eczema)

  • Adults and teenagers aged sixteen years or over should use 0.03% or 0.1% ointment, applied to the affected skin twice per day
  • Children aged between two and fifteen years should use 0.03% ointment, applied to the affected skin twice per day.
  • Children below the age of two years are not advised to use this medication.

Major Drug Interactions

Some medicines should never be used with one another under any circumstances. In other situations, two different forms of medication might be utilized at the same time, even though there is a risk of a known interaction occurring between the two of them. In cases like these, your examining doctor may wish to amend the dose of tacrolimus or may offer advice on other precautions you can take to lessen the effects of the interaction. Be sure to inform your doctor if you are currently taking any other kind of medicine, be it one prescribed by your doctor, or an over-the-counter remedy. It is especially important to inform your doctor if you are taking any of the following medications. These drugs have been listed based on the significance of their potential interactions, and the list might not be exhaustive.

Using tacrolimus alongside the following listed medications is not normally advisable. Your prescribing doctor might choose not to treat you with tacrolimus at all, or might decide to alter the other drugs you are taking.

  • Ziprasidone
  • Thioridazine
  • Terfenadine
  • Sparfloxacin
  • Saquinavir
  • Piperaquine
  • Pimozide
  • Nelfinavir
  • Mifepristone
  • Mesoridazine
  • Dronedarone
  • Cisapride
  • Bepridil
  • Amisulpride
  • Amifampridine

Using tacrolimus concurrently with these listed medications is not something that is normally advisable, although it would be a requirement in some cases. Should both drugs be prescribed at the same time, the prescribing doctor might amend the dosage or the frequency of either medication.

  • Zuclopenthixol
  • Vorinostat
  • Voriconazole
  • Vinflunine
  • Vilanterol
  • Verapamil
  • Venlafaxine
  • Vemurafenib
  • Varicella Virus Vaccine
  • Vardenafil
  • Vandetanib
  • Valdecoxib
  • Triptorelin
  • Trimipramine
  • Trazodone
  • Toremifene
  • Tolterodine
  • Tolmetin
  • Tolfenamic Acid
  • Tizanidine
  • Tiaprofenic Acid
  • Tetrabenazine
  • Tenoxicam
  • Telithromycin
  • Telavancin
  • Telaprevir
  • Tamoxifen
  • Sunitinib
  • Sulpiride
  • Sulindac
  • St John's Wort
  • Sotalol
  • Sorafenib
  • Solifenacin
  • Sodium Salicylate
  • Sodium Phosphate, Monobasic
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate
  • Sirolimus
  • Siltuximab
  • Sevoflurane
  • Sertindole
  • Secukinumab
  • Schisandra sphenanthera
  • Salsalate
  • Salicylic Acid
  • Rofecoxib
  • Ritonavir
  • Risperidone
  • Rilpivirine
  • Rifampin
  • Rifabutin
  • Ranolazine
  • Quinupristin
  • Quinine
  • Quinidine
  • Quetiapine
  • Protriptyline
  • Proquazone
  • Propyphenazone
  • Propionic Acid
  • Propafenone
  • Promethazine
  • Proglumetacin
  • Prochlorperazine
  • Procainamide
  • Probucol
  • Primidone
  • Prednisone
  • Posaconazole
  • Pixantrone
  • Pitolisant
  • Piroxicam
  • Pipamperone
  • Pimavanserin
  • Piketoprofen
  • Phenytoin
  • Phenylbutazone
  • Phenobarbital
  • Perphenazine
  • Perflutren Lipid Microsphere
  • Pentamidine
  • Pazopanib
  • Pasireotide
  • Paroxetine
  • Paritaprevir
  • Parecoxib
  • Panobinostat
  • Paliperidone
  • Oxyphenbutazone
  • Oxcarbazepine
  • Oxaprozin
  • Ondansetron
  • Omeprazole
  • Ombitasvir
  • Olanzapine
  • Ofloxacin
  • Octreotide
  • Norfloxacin
  • Nimesulide Beta Cyclodextrin
  • Nimesulide
  • Nilotinib
  • Niflumic Acid
  • Nicardipine
  • Nevirapine
  • Nepafenac
  • Nefazodone
  • Naproxen
  • Nafarelin
  • Nabumetone
  • Moxifloxacin
  • Morniflumate
  • Moricizine
  • Modafinil
  • Mizolastine
  • Mitotane
  • Mibefradil
  • Metronidazole
  • Methadone
  • Meloxicam
  • Mefloquine
  • Mefenamic Acid
  • Meclofenamate
  • Lumiracoxib
  • Lumefantrine
  • Lumacaftor
  • Loxoprofen
  • Lornoxicam
  • Levofloxacin
  • Leuprolide
  • Lapatinib
  • Ketorolac
  • Ketoprofen
  • Ketoconazole
  • Ivabradine
  • Itraconazole
  • Isavuconazonium Sulfate
  • Infliximab
  • Indomethacin
  • Indinavir
  • Imipramine
  • Imatinib
  • Iloperidone
  • Idelalisib
  • Ibutilide
  • Ibuprofen Lysine
  • Ibuprofen
  • Hydroxyzine
  • Hydroxychloroquine
  • Hydroquinidine
  • Histrelin
  • Haloperidol
  • Halofantrine
  • Grazoprevir
  • Granisetron
  • Goserelin
  • Gonadorelin
  • Golimumab
  • Gemifloxacin
  • Gatifloxacin
  • Galantamine
  • Fosphenytoin
  • Foscarnet
  • Fosaprepitant
  • Fosamprenavir
  • Formoterol
  • Flurbiprofen
  • Fluoxetine
  • Flufenamic Acid
  • Floctafenine
  • Flecainide
  • Fingolimod
  • Feprazone
  • Fepradinol
  • Fenoprofen
  • Felbinac
  • Felbamate
  • Famotidine
  • Etravirine
  • Etoricoxib
  • Etofenamate
  • Etodolac
  • Esomeprazole
  • Escitalopram
  • Erythromycin
  • Eribulin
  • Enzalutamide
  • Eluxadoline
  • Eliglustat
  • Elbasvir
  • Efavirenz
  • Echinacea
  • Ebastine
  • Droxicam
  • Droperidol
  • Doxepin
  • Donepezil
  • Domperidone
  • Dolasetron
  • Dofetilide
  • Disopyramide
  • Dipyrone
  • Diltiazem
  • Diflunisal
  • Diclofenac
  • Dexketoprofen
  • Dexibuprofen
  • Dexamethasone
  • Deslorelin
  • Desipramine
  • Delavirdine
  • Delamanid
  • Degarelix
  • Dasatinib
  • Dasabuvir
  • Darunavir
  • Dalfopristin
  • Dabrafenib
  • Cyclosporine
  • Cyclobenzaprine
  • Crizotinib
  • Conivaptan
  • Colchicine
  • Cobicistat
  • Clozapine
  • Clonixin
  • Clomipramine
  • Clarithromycin
  • Citalopram
  • Ciprofloxacin
  • Choline Salicylate
  • Chlorpromazine
  • Chloroquine
  • Ceritinib
  • Celecoxib
  • Caspofungin
  • Carbamazepine
  • Buserelin
  • Bufexamac
  • Bromfenac
  • Bosentan
  • Boceprevir
  • Blinatumomab
  • Bedaquiline
  • Azithromycin
  • Atazanavir
  • Astemizole
  • Aspirin
  • Asenapine
  • Arsenic Trioxide
  • Aripiprazole
  • Aprepitant
  • Apomorphine
  • Anagrelide
  • Amtolmetin Guacil
  • Amprenavir
  • Amlodipine
  • Amitriptyline
  • Amiodarone
  • Alfuzosin
  • Alefacept
  • Afatinib
  • Acemetacin
  • Aceclofenac

Using tacrolimus alongside these listed medicines might result in a higher risk of particular effects, but administering both medications at the same time could be the correct procedure for you. Should both medicines be used together, your prescribing doctor will likely amend the dosage and/or frequency of the drugs prior to use.

  • Nifedipine
  • Metoclopramide
  • Lansoprazole
  • Ertapenem
  • Danazol
  • Clotrimazole
  • Chloramphenicol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine or give you special instructions about the use of food, alcohol, or tobacco.

  • Ethanol

Warnings

When deciding to use a medicine like tacrolimus, you must weigh the risks of its administration against the good that it will do. This should be a decision reached between you and your prescribing doctor, following a full consultation. For tacrolimus you should consider the following:

It is vital that you inform your doctor if you have previously exhibited any allergic or otherwise unusual reaction to tacrolimus, or any other kind of medication, in the past. You should also advise your prescribing doctor or other healthcare professional if you suffer from other kinds of allergies, such as an allergic reaction to animals, foods, dyes, or preservatives.

Such appropriate studies as been performed to date have yet to demonstrate any specific problems that might inhibit the effectiveness of tacrolimus as a treatment among children aged two years or older. However, tacrolimus is not recommended for use in the treatment of children under the age of two years.

Such appropriate studies as have been performed to date have yet to demonstrate any specific problems that might inhibit the effectiveness of tacrolimus as a treatment among the elderly.

Animal studies conducted with tacrolimus have indicated that there is an adverse affect on the fetus in the womb, though there have yet to be adequate studies on the matter amongst pregnant women.

Adequate studies have yet to be conducted among women to determine the risk to nursing infants when using tacrolimus during breastfeeding. You should weigh the expected benefits of taking a course of tacrolimus against any potential risks that might arise before deciding to take a course of this drug whilst you are breastfeeding.

It is essential that you have regular consultations with your doctor whilst using tacrolimus. This will allow your doctor to determine that the medicine is working as it should, and to ensure there are no unwanted effects. If your symptoms have not improved following six weeks of your course of treatment, or should they get worse over the same time period, speak with your doctor.

Tacrolimus might increase the chance of developing lymphoma (being cancer of the lymph system) or skin cancer. If you are concerned about this, please consult your prescribing doctor.

If the symptoms of atopic dermatitis cease during your course of treatment, you should stop using tacrolimus, unless directed otherwise by your doctor.

Tacrolimus can increase the chance of developing skin tumors, particularly if exposed to the sun. During your course of treatment be sure to keep out of the sun, wherever possible, but particularly between 10:00 am and 3:00 pm, even if tacrolimus is not currently in contact with your skin. Remember to wear sunglasses, a hat, and protective clothes. Apply a high factor sunblock (SPF-15 or higher) and a sun protective lipstick, of a similar sun protection factor.

Avoid the use of sunlamps and tanning beds or booths during your course of treatment.

If you are undergoing any kind of ultraviolet light treatment, ensure your prescribing doctor is aware of this.

Should a severe reaction to the sun occur, consult your prescribing doctor.

Tacrolimus is to be administered to the skin only. Should accidental ingesting (swallowing) of the medication occur, you must call your doctor, or your local poison control center as a matter of utmost urgency.

Tacrolimus should never be applied to a skin condition that has not been examined by your prescribing doctor.

There are certain medical conditions, the presence of which may affect the efficacy of tacrolimus. Be sure to inform your doctor or health care professional if you suffer from any other medical complaint, but specifically any of the following:

  • Weakened immune system
  • history or tendency to develop problems with kidneys
  • Skin tumors
  • Skin problems, such as Netherton's syndrome, lamellar ichthyosis, or erythroderma
  • Mononucleosis (known as mono)
  • Lymphadenopathy (a disease affecting the lymph nodes)
  • Kidney failure
  • the affected areas of skin being infected
  • Cutaneous T-cell lymphoma (being a variety of skin cancer)

If suffering from any of the above conditions, tacrolimus should be used with caution, as it might make these ailments worse.

Storage

Tacrolimus should always be kept beyond the reach of children.

You should not keep hold of quantities of tacrolimus which has become outdated or is not needed any longer.

If you are unsure how to dispose of any tacrolimus ointment you will not be using, be sure to enquire with your prescribing doctor.

Tacrolimus should be stored in a sealed container, out of the way of direct light, heat, and moisture. It should be stored at room temperature, and measures taken to keep it from freezing.

The tube of tacrolimus ointment should not be left in a car during hot or cold weather, and should always be tightly closed.

Summary

Tacrolimus is a topical ointment used for suppression of the symptoms of atopic dermatitis (eczema). Eczema is a condition caused by a reaction to the body's immune system, resulting in inflammation of the skin, redness, and itching, as well as dry, flaky skin. Tacrolimus is an immunosuppressive and usually prescribed only in cases where other drugs have failed to impact upon the patient's condition.

Tacrolimus works by deliberately weakening the immune system of the skin, this decreases the patient's natural allergic reaction, which relieves atopic dermatitis.

Resources
Last Reviewed:
December 22, 2017
Last Updated:
April 03, 2018