Tacrolimus Ointment

Aka: Tacrolimus Ointment, Protopic, Elidel, Pimecrolimus

advertisement

II. Indications

  1. Severe refractory Atopic Dermatitis

III. Pharmacokinetics

  1. Normal topical use causes <5 ng/ml serum concentration
    1. Greater absorption in severely damaged skin
  2. Factors increasing serum concentrations
    1. Higher doses or greater surface area of application
    2. Inflamed skin

IV. Mechanism

  1. Macrolide with similar activity to Cyclosporine
  2. Specifically binds T Cell receptors
    1. Inhibits Cytokine production
    2. Inhibits IgE sensitivity

V. Precautions

  1. Increased risk of Skin Malignancy and Lymphoma
    1. FDA black box warning has been added
  2. Do not use for extended periods of time
  3. Use only in refractory Eczema

VI. Preparations

  1. Pimecrolimus (Elidel)
  2. Tacrolimus (Protopic)

VII. Dosing: Tracolimus

  1. Children over age 2 years: Apply 0.03% ointment bid
  2. Adults: Apply 0.03% or 0.1% ointment bid

VIII. Adverse Effects

  1. Local irritation (transient <1 week)
    1. Burning
    2. Erythema
    3. Pruritus
  2. Less common adverse effects
    1. Skin Tingling
    2. Acne
    3. Hyperesthesia
    4. Alcohol intolerance
  3. Immunosuppression related adverse effects
    1. Varicella zoster increased Incidence
    2. Eczema herpeticum
  4. Increased malignancy risk in mice (see precautions)
    1. Skin Cancer
    2. Lymphoma

IX. Precautions

  1. Protect treated areas from direct sunlight
  2. Systemic Tacrolimus associated with Skin Cancer
    1. Non-melanoma Skin Cancer

X. Advantages

  1. Very effective in refractory atopic cases
  2. Unlike Corticosteroids, does not cause skin atrophy
    1. May be useful on face and neck

XI. Disadvantages

  1. Expensive (costs per Red Book)
    1. Tacrolimus Ointment (0.03 or 0.1%): $60 per 30 grams
  2. Risk of malignancy (see prcautions)
    1. Skin Cancer
    2. Lymphoma

XII. References

  1. Bekersky (2001) J Am Acad Dermatol 44:S17 [PubMed]
  2. Hanifin (2001) J Am Acad Dermatol 44:S28 [PubMed]
  3. Kang (2001) J Am Acad Dermatol 44:S58 [PubMed]
  4. Paller (2001) J Am Acad Dermatol 44:S47 [PubMed]
  5. Ruzicka (1997) N Engl J Med 337:816 [PubMed]
  6. (2001) Med Lett Drugs Ther 43(1102):33-34 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Tacrolimus Ointment." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies

Cost: Medications

elidel (on 4/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ELIDEL 1% CREAM Generic $4.13 per gram
pimecrolimus (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
PIMECROLIMUS 1% CREAM Generic $4.13 per gram
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

advertisement