Editing Tacrolimus (section)

==Medical uses==
===Organ transplantation===
It has similar immunosuppressive properties to [[ciclosporin]], but is much more potent. Immunosuppression with tacrolimus was associated with a significantly lower rate of acute rejection compared with ciclosporin-based immunosuppression (30.7% vs 46.4%) in one study.<ref name="Medscape2004-McCauley">{{cite web | vauthors = McCauley J |date=19 May 2004 | url = http://www.medscape.com/viewarticle/474429 | title=Long-Term Graft Survival In Kidney Transplant Recipients | work=Slide Set Series on Analyses of Immunosuppressive Therapies | publisher=[[Medscape]] | access-date=6 June 2006}}</ref> Clinical outcome is better with tacrolimus than with ciclosporin during the first year of liver transplantation.<ref>{{cite journal | vauthors = Haddad EM, McAlister VC, Renouf E, Malthaner R, Kjaer MS, Gluud LL | title = Cyclosporin versus tacrolimus for liver transplanted patients | journal = The Cochrane Database of Systematic Reviews | volume = 2006 | issue = 4 | pages = CD005161 | date = October 2006 | pmid = 17054241 | pmc = 8865611 | doi = 10.1002/14651858.CD005161.pub2 | veditors = McAlister V }}</ref><ref>{{cite journal | vauthors = O'Grady JG, Burroughs A, Hardy P, Elbourne D, Truesdale A | title = Tacrolimus versus microemulsified ciclosporin in liver transplantation: the TMC randomised controlled trial | journal = Lancet | volume = 360 | issue = 9340 | pages = 1119–1125 | date = October 2002 | pmid = 12387959 | doi = 10.1016/S0140-6736(02)11196-2 | s2cid = 10417106 }}</ref> Long-term outcome has not been improved to the same extent. Tacrolimus is normally prescribed as part of a post-transplant cocktail including [[corticosteroids|steroids]], [[mycophenolate]], and [[IL-2 receptor]] inhibitors such as [[basiliximab]]. Dosages are titrated to target blood levels at specific times after medication administration.<ref>{{cite journal | vauthors = Lee MN, Butani L | title = Improved pharmacokinetic monitoring of tacrolimus exposure after pediatric renal transplantation | journal = Pediatric Transplantation | volume = 11 | issue = 4 | pages = 388–393 | date = June 2007 | pmid = 17493218 | doi = 10.1111/j.1399-3046.2006.00618.x | s2cid = 23530214 | doi-access = free }}</ref>

===Skin===
{{See also|Eczema#Medications|l1=Medications used in treatment of eczema}}
[[File:Protopic.JPG|thumb|Tacrolimus 0.1% Ointment]]

As an [[ointment]], tacrolimus is used in the treatment of [[dermatitis]] (eczema), in particular [[atopic dermatitis]], if topical corticosteroids and moisturisers fail in helping.<ref>{{cite journal |vauthors = Cury Martins J, Martins C, Aoki V, Gois AF, Ishii HA, da Silva EM |title = Topical tacrolimus for atopic dermatitis |journal = The Cochrane Database of Systematic Reviews |volume = 2015 |issue = 7 |pages = CD009864 |date = July 2015 |pmid = 26132597 |pmc = 6461158 |doi = 10.1002/14651858.CD009864.pub2 }}</ref><ref name="Cancer risk with topical calcineuri">{{cite journal |vauthors = Devasenapathy N, Chu A, Wong M, Srivastava A, Ceccacci R, Lin C, MacDonald M, Wen A, Steen J, Levine M, Pyne L, Schneider L, Chu DK |title = Cancer risk with topical calcineurin inhibitors, pimecrolimus and tacrolimus, for atopic dermatitis: a systematic review and meta-analysis |journal = The Lancet. Child & Adolescent Health |volume = 7 |issue = 1 |pages = 13–25 |date = January 2023 |pmid = 36370744 |doi = 10.1016/S2352-4642(22)00283-8 |s2cid = 253470127 }}</ref> It suppresses inflammation in a similar way to [[steroid]]s, and is equally as effective as a mid-potency steroid.  An important advantage of tacrolimus is that, unlike steroids, it does not cause skin thinning ([[atrophy]]), or other steroid related side effects.<ref name="AC-Protopic" /><ref name="Cancer risk with topical calcineuri"/>

It is applied on the active lesions until they heal off, but may also be used continuously in low doses (twice a week), and applied to the thinner skin over the face and eyelids.{{Citation needed|date=December 2008}} Clinical trials of up to one year have been conducted. Recently it has also been used to treat segmental [[vitiligo]] in children, especially in areas on the face.<ref>{{cite journal |vauthors = Silverberg NB, Lin P, Travis L, Farley-Li J, Mancini AJ, Wagner AM, Chamlin SL, Paller AS |title = Tacrolimus ointment promotes repigmentation of vitiligo in children: a review of 57 cases |journal = Journal of the American Academy of Dermatology |volume = 51 |issue = 5 |pages = 760–766 |date = November 2004 |pmid = 15523355 |doi = 10.1016/j.jaad.2004.05.036 }}</ref>

===Eyes===
Tacrolimus solution, as drops, is sometimes prescribed by veterinarians for [[keratoconjunctivitis]], and other [[dry eye]] maladies, in the eyes of domestic [[cat]]s, [[dog]]s, and [[horse]]s.<ref>{{cite web| publisher=[[Plumbs Veterinary Medication Guides]]| title=Tacrolimus, Ophthalmic| date=2017| url=https://www.mspca.org/wp-content/uploads/2017/04/Plumbs-Tacrolimus-Ophthalmic.pdf| access-date=5 August 2022| archive-date=18 December 2022| archive-url=https://web.archive.org/web/20221218152242/https://www.mspca.org/wp-content/uploads/2017/04/Plumbs-Tacrolimus-Ophthalmic.pdf| url-status=dead}}</ref>  It has been studied for use in human eyes.<ref>{{cite web| publisher=U.S. National Library of Medicine| title=Treatment of Dry Eye Using 0.03% Tacrolimus Eye Drops| date=10 May 2013| url=https://clinicaltrials.gov/ct2/show/NCT01850979| access-date=5 August 2022| vauthors = Naves FE, Sakassegawa E }}</ref><ref>{{cite journal | vauthors = Yazu H, Fukagawa K, Shimizu E, Sato Y, Fujishima H | title = Long-term outcomes of 0.1% tacrolimus eye drops in eyes with severe allergic conjunctival diseases | journal = Allergy, Asthma, and Clinical Immunology | volume = 17 | issue = 1 | pages = 11 | date = February 2021 | pmid = 33522964 | pmc = 7852099 | doi = 10.1186/s13223-021-00513-w | doi-access = free }}</ref>