Tacrolimus

Indications & Dose:

INDICATIONS AND USES:

Severe recalcitrant psoriasis*; moderate to severe atopic dermatitis/ eczema could not respose to conventional therapy.

DOSAGE

Adult

• Atopic dermatitis/eczema: TOP apply thin layer of ointment to affected areas bid; do not use occlusive dressings; continue for 1 wk after clearing of signs and symptoms

Child

• Atopic dermatitis/eczema: TOP child –>2 yr apply thin layer of ointment to affected area bid; do not use occlusive dressings; continue for 1 wk after clearing of signs and symptoms.

Contraindications:

 Hypersensitivity to HCO-60 polyoxyl 60 hydrogenated castor oil (used in vehicle for injection), concomitant use with cyclosporine (see Interactions, Drugs), avoid contact with eyes and mucous membrane, application under occulsion; congenital epidermal barrier defects; generalised erythroderma; pregnancy and breast-feeding

Side Effects:

CNS: Coma, delirium, neurotoxicity (tremor, headache, changes to motor function, mental status and sensory function), paresthesia, seizures

CV: Hypertensign peripheral edema

GI: Abdominal pain anorexia. constipation, diarrhea, elevated liver function tests, nausea, vomiting

GU: Nephrotoxicity

HEME: Anemia, leukocytosis, thrombocytopenia

METAB: Hyperglycemia, hvperkalemia (10-44%), hyperuricemia, hypokalemia. hpomagnesemia

MS: Back pain

RESP: Atelectasis, dyspnea, pleural effusion.

SKIN: Pruritus, rash

MISC: Anaphylaxis (with injection), asthenia, fever, lymphoma, pain

Cautions:

Precautions:

(increased systemic absorption of ointment), topical use in chicken pox, shingles, herpes simplex, eczema herpeticum, infection at treatment site, UV light.

Interaction:

Drugs

• Azole antifungals, bromocriptine, calcium channel blockers, cimetidine, danazol, ethinyl estradiol, GI prokinetic agents, macrolide antibiotics, nefazodone, omeprazole, protease inhibitors: Decreased metabolism or increased bioavailability of tacrolimus

• Carbamazepine, phenobarbital, phenytoin, rifamycins: Decreased tacrolimus blood levels

• Cyclosporine: Additive/synergistic nephrotoxicity, do not coadminister, discontinue tacrolimus or cyclosporine for 24 hr before starting the other

• Live vaccines: Avoid use of live vaccines, vaccinations may be less effective

• Nephrotoxic agents (aminoglycosides, amphotericin B, cisplatin, ganciclovir): Potential for additive or synergistic nephrotoxicity

• Potassium-sparing diuretics: Increased risk of hyperkalemia

• St. John’s wort (hypericum perforatum): Potential for decreased plasma tacrolimus concentrations.

Warnings:

Adverse Effects:

Lactations:

PREGNANCY AND LACTATION:

Pregnancy category C; excreted in breast milk, avoid nursing

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: