Tacrolimus

Dosage Forms Available:

  • Ophthalmic ointment 
  • Ophthalmic solution
    • Aqueous base
    • Oil base

 

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Tacrolimus is a T- cell Inhibitor immunosuppressive agent used in the adjunctive treatment of atopic dermatitis, discoid lupus erythematosus, pemphigus erythematosus or foliaceous, pinnal vascular disease, alopecia areata, vitiligo, and for perianal fistulas, sterile canine panniculitis, and proliferative and necrotizing otitis externa. Tacrolimus is used to stimulate tear production in dogs that do not respond to cyclosporine. Tacrolimus can also be used to manage chronic superficial keratitis (CSK).

What is Tacrolimus?

Tacrolimus acts by inhibiting T-lymphocyte activation, primarily by inhibiting the phosphatase activity of calcineurin. It also inhibits the release of inflammatory cytokines and mediators from mast cells and basophils. 

What is Tacrolimus Used for In Dogs?

Tacrolimus 

Tacrolimus is used to stimulate tear production in dogs that do not respond to cyclosporine. Tacrolimus can also be used to manage chronic superficial keratitis (CSK). Ophthalmic Tacrolimus is used to treat dogs with keratoconjunctivitis sicca (KCS) and other immune-mediated ocular surface inflammatory conditions. It is useful for cyclosporine-resistant cases of KCS.

Tacrolimus requires a prescription from your veterinarian. 

 Tacrolimus Side Effects

Side effects of Tacrolimus are: 

Common Side Effects 

  • Localized irritation
  • pruritus

Less Common Side Effects

  • orbital alopecia (may be related to oil vehicles used for compounding)
  • Unlike topical corticosteroids, Tacrolimus does not have atrophogenic or metabolic effects associated with long-term use or large area treatment.

If you notice any of these Tacrolimus side effects in horses, cats, or dogs, contact your veterinarian right away. In the event of an allergic reaction, seek immediate medical attention for your animal.

Tacrolimus Precautions

  • Systemic use of Tacrolimus is associated with significant systemic toxicities in dogs
  • Wear gloves or use an applicator when applying the ointment. Tacrolimus has FDA-mandated “black box” warning indicating that use may increase the risk for skin cancer and lymphomas in humans, although a causal relationship has not been established. 

DO NOT use the commercially available ointment in the eye. It contains propylene carbonate, a known ocular toxin.

Tacrolimus may not be the best treatment for all veterinary patients.

        Who Should Not Use Tacrolimus?

  • Tacrolimus is contraindicated in patients with a history of hypersensitivity to it or any component of the formulation.

Are There Any Drug Interactions With Tacrolimus?

Tacrolimus should not be mixed directly with any other drugs. 

Talk to your veterinarian before giving any prescription or over-the-counter medicines, including vitamins and minerals. 

Are There Any Risk Factors Associated With This Medication?

If any of the following serious side effects occur, stop giving Tacrolimus and seek emergency veterinary medical attention; an allergic reaction (difficulty breathing; swelling of the lips, tongue, or face; hives), scratching, sudden onset of diarrhea, vomiting, shock, seizures, pale gums, coma.

 Discontinue giving Tacrolimus and contact your veterinarian if your pet develops; poor appetite, drowsiness, diarrhea, labored breathing, weakness, incoordination, fainting, accumulation of fluid in the lungs or abdomen, and cough. Other side effects may also occur. 

Talk to your veterinarian about any side effect that seems unusual or bothersome to the pet. 

Storage

Store at controlled room temperature in a tightly sealed container and keep away from direct sunlight and moisture (do not refrigerate or freeze).

Medication should not be ingested by humans. In homes with children, a childproof container is recommended. If a human accidentally swallows this medication, call your doctor right away.

Instructions

Use proper administration techniques to avoid contamination of the medication. Keep bottle cap tightly closed when not in use.

Wait 5-10mins after applying Tacrolimus before applying any other medication to the eye.

Give this medication exactly as directed by your veterinarian. If you do not understand these directions ask the veterinarian to explain them to you.

Be certain to complete the prescription unless specifically directed by your veterinarian. 

Even if your pet feels better, the entire treatment plan should be completed to prevent relapse or prevent resistance development.

Timeline Tips

  • Follow your veterinarian’s instructions as they may differ from these recommendations.
  • Finish the package and administer all doses. Don’t cease medication until your veterinarian has instructed.

Tacrolimus Dosage

  • It is normally used two times daily
  • It’s a lifelong medication and must be given daily
  • Missed doses may cause a rapid return of KCS

Always follow your veterinarian’s directions strictly.

Missed Dose

To maintain the medication’s effectiveness, be careful not to miss a dose and have the refill on the way before you run out.

In the case of a missed dose, keep up the regular schedule whenever possible. Skip the missed dose if it’s almost time for the next dose, then with the regular schedule. 

Doubling up is not advised.

Contact your veterinarian if signs of side effects develop.

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