Editing Tacrolimus (section)

==Side effects==
===By mouth or intravenous use===
Side effects can be severe and include [[infection]], cardiac damage, [[hypertension]], [[blurred vision]], liver and [[kidney]] problems (tacrolimus [[nephrotoxicity]]),<ref name="pmid19218475">{{cite journal | vauthors = Naesens M, Kuypers DR, Sarwal M | title = Calcineurin inhibitor nephrotoxicity | journal = Clinical Journal of the American Society of Nephrology | volume = 4 | issue = 2 | pages = 481–508 | date = February 2009 | pmid = 19218475 | doi = 10.2215/CJN.04800908 | doi-access = free }}</ref> [[hyperkalemia]], [[hypomagnesemia]], [[hyperglycemia]], [[diabetes mellitus]], [[itch]]ing, lung damage ([[sirolimus]] also causes lung damage),<ref>{{cite journal | vauthors = Miwa Y, Isozaki T, Wakabayashi K, Odai T, Matsunawa M, Yajima N, Negishi M, Ide H, Kasama T, Adachi M, Hisayuki T, Takemura T | title = Tacrolimus-induced lung injury in a rheumatoid arthritis patient with interstitial pneumonitis | journal = Modern Rheumatology | volume = 18 | issue = 2 | pages = 208–211 | year = 2008 | pmid = 18306979 | doi = 10.1007/s10165-008-0034-3 | s2cid = 39537409 }}</ref> and various neuropsychiatric problems such as loss of appetite, [[insomnia]], [[posterior reversible encephalopathy syndrome]], confusion, weakness, [[Depression (mood)|depression]], vivid nightmares, [[cramp]]s, [[neuropathy]], [[seizure]]s, [[tremor]]s, and [[catatonia]].<ref>{{cite journal | vauthors = O'Donnell MM, Williams JP, Weinrieb R, Denysenko L | title = Catatonic mutism after liver transplant rapidly reversed with lorazepam | journal = General Hospital Psychiatry | volume = 29 | issue = 3 | pages = 280–281 | year = 2007 | pmid = 17484951 | doi = 10.1016/j.genhosppsych.2007.01.004 }}
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In addition, it may potentially increase the severity of existing fungal or infectious conditions such as [[varicella-zoster virus|herpes zoster]] or [[polyomavirus|polyoma]] viral infections.<ref name="AC" />

====Carcinogenesis and mutagenesis====
In people receiving immunosuppressants to reduce transplant graft rejection, an increased risk of malignancy (cancer) is a recognised complication.<ref name="AC" /> The most common cancers are [[non-Hodgkin's lymphoma]]<ref>{{Cite web|url=https://www.cancer.org/cancer/non-hodgkin-lymphoma/about/key-statistics.html|title=Key Statistics for Non-Hodgkin Lymphoma|website=www.cancer.org|access-date=19 February 2020}}</ref> and [[skin cancer]]s. The risk appears to be related to the intensity and duration of treatment.

===Topical use===
The most common adverse events associated with the use of topical tacrolimus ointments, especially if used over a wide area, include a burning or itching sensation on the initial applications, with increased sensitivity to sunlight and heat on the affected areas.{{Citation needed|date=January 2022}} Less common are [[flu-like symptoms]], headache, cough, and burning eyes.<ref name="JAcadDerm-Hanifin">{{cite journal | vauthors = Hanifin JM, Paller AS, Eichenfield L, Clark RA, Korman N, Weinstein G, Caro I, Jaracz E, Rico MJ | title = Efficacy and safety of tacrolimus ointment treatment for up to 4 years in patients with atopic dermatitis | journal = Journal of the American Academy of Dermatology | volume = 53 | issue = 2 Suppl 2 | pages = S186–S194 | date = August 2005 | pmid = 16021174 | doi = 10.1016/j.jaad.2005.04.062 }}</ref>

====Cancer risks====
{{Further|Eczema#Medications}}
Tacrolimus and a related drug for eczema ([[pimecrolimus]]) were suspected of carrying a cancer risk, though the matter is still a subject of controversy. The FDA issued a health warning in March 2005 for the drug, based on animal models and a small number of patients. Until further human studies yield more conclusive results, the FDA recommends that users be advised of the potential risks. However, current practice by [[United Kingdom|UK]]  dermatologists is not to consider this a significant real concern and they are increasingly recommending the use of these new drugs.<ref name="BAD2002">{{cite web  | vauthors = Cox NH, Smith CH |date=December 2002  |url=http://www.bad.org.uk/Portals/_Bad/Guidelines/Position%20Statements%20&%20Other%20Documents/Advice%20re%20topical%20tacrolimus.pdf  |title=Advice to dermatologists re topical tacrolimus  |work=Therapy Guidelines Committee  |publisher=British Association of Dermatologists  |url-status=dead  |archive-url=https://web.archive.org/web/20131213072822/http://www.bad.org.uk/Portals/_Bad/Guidelines/Position%20Statements%20%26%20Other%20Documents/Advice%20re%20topical%20tacrolimus.pdf  |archive-date=13 December 2013  }}</ref> A 2023 systematic review and meta-analysis published in [[The Lancet Child & Adolescent Health]] concluded with moderate-certainty evidence that the two drugs were not associated with any increased risk of cancer.<ref>{{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 | language = English | 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>

In November 2024, [[International Agency for Research on Cancer]] (IARC) classified [[hydrochlorothiazide]], [[voriconazole]] and tacrolimus as [[IARC group 1|group 1 carcinogens]].<ref name=IARCarticle2024>{{cite journal |url=https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(24)00685-5/fulltext |title=Carcinogenicity of hydrochlorothiazide, voriconazole, and tacrolimus |journal=The Lancet Oncology|date=2024-11-29 |volume=26 |issue=1 |pages=15–16 |doi=10.1016/S1470-2045(24)00685-5 |author=Cogliano VJ, Corsini E, Fournier A, Nelson HH, Sergi CM, Antunes AMM|pmid=39622256 |display-authors=etal}}</ref><ref name=IARClist>{{cite web |url=https://monographs.iarc.who.int/list-of-classifications |title=List of Classifications|work=IARC|access-date=2025-04-12}}</ref>