Tacrolimus ointment: Uses, How to Use it, Side Effects, Interactions

Tacrolimus ointment belongs to a broad class of medications known as immunosuppressants. It works by decreasing the activity of the immune system to prevent it from attacking the transplanted organ. Tacrolimus ointment is used to treat the symptoms of eczema (atopic dermatitis; a skin disease that causes the skin to be dry and itchy and to sometimes develop red, scaly rashes) in patients who cannot use other medications for their condition or whose eczema has not responded to another medication.

How tacrolimus ointment works

People with eczema tend to have an over-reactive immune system. When triggered by a substance inside or outside the body, the immune system responds by producing inflammation. It is this inflammatory response that causes the itchy, painful, rash-like symptoms common to several types of eczema. Tacrolimus is in a sub-class of medications called topical calcineurin inhibitors. It works by stopping the immune system from producing substances that may cause eczema.

How effective is tacrolimus ointment for eczema?

Studies have shown that both tacrolimus strengths (0.03% and 0.1%) ointments are superior to low-potency topical corticosteroids, whereas tacrolimus 0.1% has similar effectiveness to moderate- to high-potency topical corticosteroids. A mild, self-limited, local burning sensation is common with use.

How should tacrolimus ointment be used?

Tacrolimus comes as an ointment to apply to the skin. It is usually applied twice a day to the affected area. To help you remember to apply tacrolimus ointment, apply it at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use tacrolimus exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

To use the ointment, follow these steps:

• Wash your hands with soap and water.
• Be sure that the skin in the affected area is dry.
• Apply a thin layer of tacrolimus ointment to all affected areas of your skin.
• Rub the ointment into your skin gently and completely.
• Wash your hands with soap and water to remove any leftover tacrolimus ointment. Do not wash your hands if you are treating them with tacrolimus.

You may cover the treated areas with normal clothing, but do not use any bandages, dressings, or wraps.

Be careful not to wash the ointment off of affected areas of your skin. Do not swim, shower, or bathe immediately after applying tacrolimus ointment.

What should I do if I forget a dose?

Apply the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not apply extra ointment to make up for a missed dose.

What if I overdose?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

What are the side effects of tacrolimus ointment?

Tacrolimus ointment may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• acne
• flu-like symptoms
• headache
• increased sensitivity of the skin to hot or cold temperatures
• itching
• muscle or back pain
• nausea
• skin burning, stinging, redness or soreness
• stuffy or runny nose
• swollen or infected hair follicles
• tingling skin

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

• chickenpox or other blisters
• cold sores
• crusting, oozing, blistering or other signs of skin infection
• rash
• swelling of the hands, arms, feet, ankles, or lower legs
• swollen glands

Tacrolimus ointment may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What drugs can interact with tacrolimus?

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. 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 medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

•          Bepridil

•          Cisapride

•          Dronedarone

•          Fluconazole

•          Lefamulin

•          Mesoridazine

•          Mifepristone

•          Nelfinavir

•          Pimozide

•          Piperaquine

•          Posaconazole

•          Ritonavir

•          Saquinavir

•          Sparfloxacin

•          Terfenadine

•          Thioridazine

•          Ziprasidone

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

•          Abametapir

•          Aceclofenac

•          Acemetacin

•          Adenovirus Vaccine, Live

•          Alefacept

•          Alfuzosin

•          Amiodarone

•          Amisulpride

•          Amitriptyline

•          Amlodipine

•          Amprenavir

•          Amtolmetin Guacil

•          Anagrelide

•          Apomorphine

•          Aprepitant

•          Aripiprazole

•          Aripiprazole Lauroxil

•          Armodafinil

•          Arsenic Trioxide

•          Asciminib

•          Asenapine

•          Aspirin

•          Astemizole

•          Atazanavir

•          Avacopan

•          Azithromycin

•          Bacillus of Calmette and Guerin Vaccine, Live

•          Bedaquiline

•          Belzutifan

•          Berotralstat

•          Boceprevir

•          Bosentan

•          Bromfenac

•          Bufexamac

•          Buprenorphine

•          Buserelin

•          Cannabidiol

•          Carbamazepine

•          Caspofungin

•          Celecoxib

•          Cenobamate

•          Ceritinib

•          Chloramphenicol

•          Chloroquine

•          Chlorpromazine

•          Cholera Vaccine, Live

•          Choline Salicylate

•          Ciprofloxacin

•          Citalopram

•          Clarithromycin

•          Clofazimine

•          Clomipramine

•          Clonixin

•          Clotrimazole

•          Clozapine

•          Cobicistat

•          Colchicine

•          Conivaptan

•          Crizotinib

•          Cyclobenzaprine

•          Cyclosporine

•          Dabrafenib

•          Dalfopristin

•          Darunavir

•          Dasabuvir

•          Dasatinib

•          Degarelix

•          Delamanid

•          Delavirdine

•          Dengue Tetravalent Vaccine, Live

•          Desipramine

•          Deslorelin

•          Deutetrabenazine

•          Dexamethasone

•          Dexibuprofen

•          Dexketoprofen

•          Diclofenac

•          Diflunisal

•          Diltiazem

•          Dipyrone

•          Disopyramide

•          Dofetilide

•          Dolasetron

•          Domperidone

•          Donepezil

•          Doxepin

•          Droperidol

•          Droxicam

•          Ebastine

•          Echinacea

•          Efavirenz

•          Elbasvir

•          Eliglustat

•          Eluxadoline

•          Encorafenib

•          Entrectinib

•          Enzalutamide

•          Erdafitinib

•          Eribulin

•          Erythromycin

•          Escitalopram

•          Eslicarbazepine Acetate

•          Esomeprazole

•          Etodolac

•          Etofenamate

•          Etoricoxib

•          Etravirine

•          Famotidine

•          Felbamate

•          Felbinac

•          Fenoprofen

•          Fentanyl

•          Fepradinol

•          Feprazone

•          Fexinidazole

•          Fingolimod

•          Flecainide

•          Floctafenine

•          Flufenamic Acid

•          Fluoxetine

•          Flurbiprofen

•          Fluvoxamine

•          Formoterol

•          Fosamprenavir

•          Fosaprepitant

•          Foscarnet

•          Fosnetupitant

•          Fosphenytoin

•          Fostemsavir

•          Galantamine

•          Gatifloxacin

•          Gemifloxacin

•          Glasdegib

•          Gonadorelin

•          Goserelin

•          Granisetron

•          Grazoprevir

•          Halofantrine

•          Haloperidol

•          Histrelin

•          Hydroquinidine

•          Hydroxychloroquine

•          Hydroxyzine

•          Ibuprofen

•          Ibuprofen Lysine

•          Ibutilide

•          Idelalisib

•          Iloperidone

•          Imatinib

•          Imipramine

•          Indinavir

•          Indomethacin

•          Infliximab

•          Influenza Virus Vaccine, Live

•          Inotuzumab Ozogamicin

•          Isavuconazonium Sulfate

•          Itraconazole

•          Ivabradine

•          Ivacaftor

•          Ivosidenib

•          Ketoconazole

•          Ketoprofen

•          Ketorolac

•          Lanreotide

•          Lapatinib

•          Lenvatinib

•          Letermovir

•          Levamlodipine

•          Levofloxacin

•          Lofexidine

•          Lomitapide

•          Lopinavir

•          Lorlatinib

•          Lornoxicam

•          Loxoprofen

•          Lumacaftor

•          Lumefantrine

•          Lumiracoxib

•          Macimorelin

•          Measles Virus Vaccine, Live

•          Meclofenamate

•          Mefenamic Acid

•          Mefloquine

•          Meloxicam

•          Methadone

•          Methotrimeprazine

•          Metoclopramide

•          Metronidazole

•          Mibefradil

•          Mirtazapine

•          Mitotane

•          Mizolastine

•          Mobocertinib

•          Modafinil

•          Moricizine

•          Morniflumate

•          Moxifloxacin

•          Mumps Virus Vaccine, Live

•          Nabumetone

•          Nafarelin

•          Nafcillin

•          Naproxen

•          Nefazodone

•          Nepafenac

•          Netupitant

•          Nevirapine

•          Nicardipine

•          Niflumic Acid

•          Nilotinib

•          Nimesulide

•          Nimesulide Beta Cyclodextrin

•          Norfloxacin

•          Octreotide

•          Ofloxacin

•          Olanzapine

•          Ombitasvir

•          Omeprazole

•          Ondansetron

•          Osilodrostat

•          Osimertinib

•          Oxaliplatin

•          Oxaprozin

•          Oxcarbazepine

•          Oxyphenbutazone

•          Ozanimod

•          Palbociclib

•          Paliperidone

•          Panobinostat

•          Papaverine

•          Parecoxib

•          Paritaprevir

•          Paroxetine

•          Pasireotide

•          Pazopanib

•          Pentamidine

•          Perphenazine

•          Phenobarbital

•          Phenylbutazone

•          Phenytoin

•          Piketoprofen

•          Pimavanserin

•          Pipamperone

•          Piroxicam

•          Pixantrone

•          Poliovirus Vaccine, Live

•          Ponesimod

•          Potassium Phosphate

•          Prednisone

•          Primidone

•          Probucol

•          Procainamide

•          Prochlorperazine

•          Proglumetacin

•          Promethazine

•          Propafenone

•          Propionic Acid

•          Propyphenazone

•          Proquazone

•          Protriptyline

•          Quetiapine

•          Quinidine

•          Quinine

•          Quinupristin

•          Ranitidine

•          Ranolazine

•          Ribociclib

•          Rifabutin

•          Rifampin

•          Rifapentine

•          Risperidone

•          Rofecoxib

•          Rotavirus Vaccine, Live

•          Rubella Virus Vaccine, Live

•          Salicylic Acid

•          Salsalate

•          Schisandra sphenanthera

•          Selpercatinib

•          Sertindole

•          Sertraline

•          Sevoflurane

•          Siponimod

•          Sirolimus

•          Smallpox Vaccine

•          Sodium Phosphate

•          Sodium Phosphate, Dibasic

•          Sodium Phosphate, Monobasic

•          Sodium Salicylate

•          Solifenacin

•          Sorafenib

•          Sotalol

•          Sotorasib

•          St John’s Wort

•          Sulindac

•          Sulpiride

•          Sultopride

•          Sunitinib

•          Tamoxifen

•          Telaprevir

•          Telavancin

•          Telithromycin

•          Tenoxicam

•          Tetrabenazine

•          Tiaprofenic Acid

•          Tofacitinib

•          Tolfenamic Acid

•          Tolmetin

•          Tolterodine

•          Toremifene

•          Trazodone

•          Triclabendazole

•          Trimipramine

•          Triptorelin

•          Tucatinib

•          Typhoid Vaccine, Live

•          Valdecoxib

•          Vandetanib

•          Vardenafil

•          Varicella Virus Vaccine, Live

•          Vemurafenib

•          Venlafaxine

•          Verapamil

•          Vilanterol

•          Vinflunine

•          Voclosporin

•          Voriconazole

•          Vorinostat

•          Voxelotor

•          Yellow Fever Vaccine

•          Zoster Vaccine, Live

•          Zotepine

•          Zuclopenthixol

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

•          Aluminum Carbonate, Basic

•          Aluminum Hydroxide

•          Aluminum Phosphate

•          Danazol

•          Dihydroxyaluminum Aminoacetate

•          Dihydroxyaluminum Sodium Carbonate

•          Ertapenem

•          Lansoprazole

•          Magnesium Carbonate

•          Magnesium Hydroxide

•          Magnesium Oxide

•          Magnesium Trisilicate

•          Nifedipine

•          Tigecycline

Other Interactions

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

•          Grapefruit Juice

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

•          Congestive heart failure or

•          Diabetes or

•          Heart disease or

•          Heart rhythm problems (eg, QT prolongation), or history of or

•          Hyperkalemia (high potassium in the blood) or

•          Hypertension (high blood pressure) or

•          Myocardial hypertrophy (heart is larger than normal), history of or

•          Paresthesia (numbness or tingling in the hands, arms, legs, or feet), history of or

•          Seizures (convulsions), history of or

•          Tremors—Use with caution. May make these conditions worse.

•          Cystic fibrosis—May require a higher dose for patients with this condition.

•          Infection, active (eg, bacteria, fungus, or virus)—May decrease your body’s ability to fight an infection.

•          Kidney disease or

•          Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.