Tacrolimus

What is Tacrolimus

Tacrolimus is a calcineurin-inhibitor immunosuppressive agent that has been studied in patients receiving heart, kidney, liver, lung, pancreas, small bowel, or bone marrow transplants.

Tacrolimus has been shown to be effective in graft rejection prophylaxis and in the management of acute and steroid- or cyclosporine-resistant transplant rejection, and it is considered an alternative to cyclosporine immunosuppression.

Tacrolimus has been shown to be 10 to100 times more potent than cyclosporine. 

Indications

1. atopic dermatitis
2. contact dermatitis
3. graft-versus-host disease (GVHD)
4. graft-versus-host disease (GVHD) prophylaxis
5. heart transplant rejection
6. heart transplant rejection prophylaxis
7. kidney transplant rejection
8. kidney transplant rejection prophylaxis
9. lichen sclerosus
10. liver transplant rejection
11. liver transplant rejection prophylaxis
12. lung transplant rejection
13. lung transplant rejection prophylaxis
14. lupus nephritis
15. nephrotic syndrome
16. pancreas transplant rejection prophylaxis
17. psoriasis
18. small bowel transplant rejection prophylaxis
19. ulcerative colitis
20. uveitis

Side Effects

1. abdominal pain
2. abnormal dreams
3. acne vulgaris
4. acute respiratory distress syndrome (ARDS)
5. agitation
6. agranulocytosis
7. alopecia
8. amblyopia
9. amnesia
10. anaphylactic shock
11. anaphylactoid reactions
12. anasarca
13. anemia
14. angina
15. angioedema
16. anorexia
17. anuria
18. anxiety
19. aphasia
20. appetite stimulation
21. arrhythmia exacerbation
22. arthralgia
23. arthropathy
24. ascites
25. asthenia
26. atrial fibrillation
27. atrial flutter
28. back pain
29. BK virus-associated nephropathy
30. bladder spasm
31. blepharitis
32. blurred vision
33. bradycardia
34. cardiac arrest
35. cardiac valvulopathy
36. cardiomyopathy
37. cataracts
38. chest pain (unspecified)
39. chills
40. cholangitis
41. cholestasis
42. cirrhosis
43. coagulopathy
44. colitis
45. confusion
46. conjunctivitis
47. constipation
48. cough
49. Cushing’s syndrome
50. Cushingoid features
51. cystitis
52. dehydration
53. delirium
54. depression
55. diabetes mellitus
56. diaphoresis
57. diarrhea
58. disseminated intravascular coagulation (DIC)
59. dizziness
60. drowsiness
61. dysgeusia
62. dysmenorrhea
63. dyspepsia
64. dysphagia
65. dyspnea
66. dysuria
67. ecchymosis
68. edema
69. elevated hepatic enzymes
70. emotional lability
71. encephalopathy
72. epistaxis
73. erythema
74. esophageal ulceration
75. esophagitis
76. exfoliative dermatitis
77. fatigue
78. fever
79. flatulence
80. flushing
81. folliculitis
82. furunculosis
83. gastritis
84. gastroesophageal reflux
85. GI bleeding
86. GI perforation
87. glycosuria
88. gout
89. graft-versus-host disease (GVHD)
90. hallucinations
91. headache
92. hearing loss
93. heart failure
94. heat intolerance
95. hematuria
96. hemolytic anemia
97. hemolytic-uremic syndrome
98. hemorrhagic cystitis
99. hepatic failure
100. hepatic necrosis
101. hepatitis
102. hiccups
103. hirsutism
104. hyperbilirubinemia
105. hypercalcemia
106. hypercholesterolemia
107. hyperesthesia
108. hyperglycemia
109. hyperhidrosis
110. hyperkalemia
111. hyperlipidemia
112. hyperphosphatemia
113. hypertension
114. hypertriglyceridemia
115. hyperuricemia
116. hypervolemia
117. hypocalcemia
118. hypoesthesia
119. hypoglycemia
120. hypokalemia
121. hypomagnesemia
122. hyponatremia
123. hypophosphatemia
124. hypotension
125. hypothyroidism
126. ileus
127. immunosuppression
128. impaired wound healing
129. inconsolable crying
130. infection
131. influenza
132. insomnia
133. jaundice
134. laryngitis
135. leukocytosis
136. leukoencephalopathy
137. leukopenia
138. lymphoma
139. maculopapular rash
140. metabolic acidosis
141. metabolic alkalosis
142. migraine
143. muscle cramps
144. myalgia
145. myasthenia
146. myocardial infarction
147. myoclonia
148. nausea
149. nephrotoxicity
150. neurotoxicity
151. neutropenia
152. new primary malignancy
153. nightmares
154. nocturia
155. ocular pain
156. oliguria
157. optic atrophy
158. orthostatic hypotension
159. osteomyelitis
160. osteopenia
161. osteoporosis
162. otalgia
163. pancreatitis
164. pancytopenia
165. paresthesias
166. pericardial effusion
167. peripheral edema
168. peripheral neuropathy
169. peripheral vasodilation
170. pharyngitis
171. phlebitis
172. photophobia
173. photosensitivity
174. pleural effusion
175. pneumothorax
176. polycythemia
177. post-transplant lymphoproliferative disorder (PTLD)
178. proteinuria
179. pruritus
180. psychomotor impairment
181. psychosis
182. pulmonary edema
183. pulmonary embolism
184. pulmonary hypertension
185. pyuria
186. QT prolongation
187. rash
188. red cell aplasia
189. renal failure (unspecified)
190. renal tubular necrosis
191. rhabdomyolysis
192. rhinitis
193. seborrhea
194. seizures
195. sinus tachycardia
196. sinusitis
197. skin discoloration
198. skin hyperpigmentation
199. skin ulcer
200. Stevens-Johnson syndrome
201. stomatitis
202. stroke
203. supraventricular tachycardia (SVT)
204. syncope
205. thrombocytopenia
206. thrombosis
207. thrombotic microangiopathy
208. thrombotic thrombocytopenic purpura (TTP)
209. tinnitus
210. torsade de pointes
211. toxic epidermal necrolysis
212. tremor
213. urinary incontinence
214. urinary retention
215. urinary urgency
216. urticaria
217. vaginitis
218. veno-occlusive disease (VOD)
219. ventricular fibrillation
220. vertigo
221. vesicular rash
222. vomiting
223. weight gain
224. weight loss
225. xerophthalmia
226. xerosis
227. xerostomia

Monitoring Parameters

• blood glucose
• CBC
• LFTs
• serum creatinine/BUN
• serum electrolytes
• serum lipid profile
• serum potassium
• serum tacrolimus concentrations
• skin cancer screening exam

Contraindications

• alcoholism
• Black patients
• bradycardia
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• cardiomyopathy
• children
• coronary artery disease
• diabetes mellitus
• exfoliative dermatitis
• females
• fungal infection
• geriatric
• heart failure
• hepatic disease
• herpes infection
• Hispanic patients
• hyperglycemia
• hyperkalemia
• hypertension
• hypocalcemia
• hypokalemia
• hypomagnesemia
• ichthyosis
• immunosuppression
• infants
• infection
• infertility
• intravenous administration
• liver transplant
• long QT syndrome
• lymphoma
• malnutrition
• mononucleosis
• myocardial infarction
• neonates
• new primary malignancy
• occlusive dressing
• ocular exposure
• oliguria
• polyoxyethylated castor oil hypersensitivity
• post-transplant lymphoproliferative disorder (PTLD)
• pregnancy
• QT prolongation
• red cell aplasia
• renal disease
• renal failure
• renal impairment
• reproductive risk
• requires a specialized care setting
• requires an experienced clinician
• seizure disorder
• seizures
• skin cancer
• sunlight (UV) exposure
• thyroid disease
• vaccination
• varicella
• viral infection

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