Drug Action
Tacrolimus is a calcineurin inhibitor.
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Drug reference
Tacrolimus is a calcineurin inhibitor.
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Short-term treatment of moderate to severe atopic eczema (including flares) in patients unresponsive to, or intolerant of conventional therapy (initiated by a specialist) ▶TO THE SKIN ▶Adult: Apply twice daily until lesion clears (consider other treatment if eczema worsens or no improvement after 2 weeks), initially 0.1% ointment to be applied thinly, reduce frequency to once daily or strength of ointment to 0.03% if condition allows Prevention of flares in patients with moderate to severe atopic eczema and 4 or more flares a year who have responded to initial treatment with topical tacrolimus (initiated by a specialist) ▶TO THE SKIN ▶Adult: Apply twice weekly, 0.1% ointment to be applied thinly, with an interval of 2–3 days between applications, use short-term treatment regimen during an acute flare; review need for preventative therapy after 1 year Short-term treatment of facial, flexural, or genital psoriasis in patients unresponsive to, or intolerant of other topical therapy (initiated under specialist supervision) ▶TO THE SKIN ▶Adult: Apply twice daily until symptoms resolve, 0.1% ointment to be applied thinly, reduce to once daily or switch to 0.03% ointment if condition allows, maximum duration of treatment 4 weeks l UNLICENSED USE Short-term treatment of facial, flexural, or genital psoriasis is unlicensed.
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Application to malignant or potentially malignant skin lesions. application under occlusion. avoid contact with eyes. avoid contact with mucous membranes. congenital epidermal barrier defects. generalised erythroderma. immunodeficiency. infection at treatment site
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UV light (avoid excessive exposure to sunlight and sunlamps)
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Contra-indicated if history of hypersensitivity to macrolides.
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NICE decisions Skin ▶Tacrolimus and pimecrolimus for atopic eczema (August 2004) NICE TA82 Topical tacrolimus is an option for atopic eczema not controlled by maximal topical corticosteroid treatment or if there is a risk of important corticosteroid side-effects (particularly skin atrophy). Topical tacrolimus is recommended as an option for the second-line treatment for moderate to severe atopic eczema in adults and children over 2 years.Tacrolimus should be used within its licensed indications. www.nice.org.uk/guidance/TA82 Scottish Medicines Consortium (SMC) decisions The Scottish Medicines Consortium has advised (April 2010) that tacrolimus 0.1 % ointment (Protopic ®) is accepted for restricted use within NHS Scotland for the prevention of flares in patients aged 16 years and over with moderate-to- severe atopic eczema in accordance with the licensed indications; initiation of treatment is restricted to doctors (including general practitioners) with a specialist interest and experience in treating atopic eczema with immunomodulatory therapy.
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→Appendix 1: tacrolimus
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▶Common or very common Alcohol intolerance. increased risk of infection. sensation abnormal. skin reactions ▶Uncommon Lymphadenopathy ▶Frequency not known Malignancy. neoplasms
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Manufacturer advises avoid unless essential; toxicity in animal studies following systemic administration.
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Avoid—present in breast milk (following systemic administration).
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Manufacturer advises caution in hepatic failure.
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There can be variation in the licensing of different medicines containing the same drug. Ointment CAUTIONARY AND ADVISORY LABELS 4, 11, 28 EXCIPIENTS: May contain Beeswax ▶Tacrolimus (Non-proprietary) Tacrolimus (as Tacrolimus monohydrate) 1 mg per 1 gram Tacrolimus 0.1% ointment | 30 gram P £25.96 DT = £18.88 | 60 gram P £51.91 DT = £37.76 ▶Protopic (LEO Pharma) Tacrolimus (as Tacrolimus monohydrate) 300 microgram per 1 gram Protopic 0.03% ointment | 30 gram P £23.33 DT = £23.33 | 60 gram P £42.55 DT = £42.55 Tacrolimus (as Tacrolimus monohydrate) 1 mg per 1 gram Protopic 0.1% ointment | 30 gram P £25.92 DT = £18.88 | 60 gram P £47.28 DT = £37.76 IMMUNOSUPPRESSANTS › INTERLEUKIN INHIBITORS
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Avoid excessive exposure to UV light including sunlight.
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Apply twice daily until lesion clears (consider
First-line fragment. Read the complete Indications and Dose section above.
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Apply twice weekly, 0.1% ointment to be applied
First-line fragment. Read the complete Indications and Dose section above.
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Apply twice daily until symptoms resolve, 0.1%
First-line fragment. Read the complete Indications and Dose section above.
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