Tacrolimus Ophthalmic

By Rania Gollakner, BS, DVM, MPH

What is tacrolimus?

Tacrolimus ophthalmic is an immunosuppressive agent used to treat keratoconjunctivitis sicca (KCS), also known as dry eye. It can also be used for other immune mediated eye conditions such as chronic superficial keratitis (CSK). It is not commercially produced and must be specially compounded by a pharmacy.

Its use in dogs, cats, and other animals to treat dry eye and other immune-mediated eye conditions is ‘off label’ or ‘extra label’. Many drugs are commonly prescribed for off label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions very carefully as their directions may be significantly different from those on the label.

How is tacrolimus given?

Tacrolimus is applied to the eye, usually twice daily, in the form of an ointment or liquid solution. Wash your hands before administering this medication. Do not touch the tip of the dropper or ointment tube to the surface of the eye or any other surface. Give this medication at least 5 minutes apart from other medications used in the eye. Wipe off excess medication on the face with a damp cloth or tissue. Do not give this to your pet if the medication is cloudy or changes color. Pregnant women should NOT handle this medication; if it is necessary, wear gloves and wash hands immediately after administering.

This medication can take up to a few weeks before full effects are noted, but gradual improvements are usually noticeable after a few days.

What if I miss giving my pet the medication?

If you miss a dose, give it when you remember, but if it is close to the time for the next dose, skip the dose you missed and give it at the next scheduled time, and return to the regular dosing schedule. Never give your pet two doses at once or give extra doses.

Are there any potential side effects?

Side effects are uncommon but may include mild irritation upon application, eyelid twitches, or hair loss around the eye. Serious side effects include difficulty breathing, facial swelling, hives, weakness, or tiredness. This moderate-acting medication should stop working in a few days.

Are there any risk factors for this medication?

Tacrolimus ophthalmic  should not be used in pets that are allergic to it or in pets that have a viral or fungal infection in the eye. Do not allow your pet to ingest this medication as it can be toxic when eaten. It should be used cautiously in pregnant or nursing pets.

Are there any drug interactions I should be aware of?

There are no specific drug interactions with tacrolimus ophthalmic. Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking.

Is there any monitoring that needs to be done with this medication?

When used to treat dry eye, your pet’s tear production will be monitored via regular eye exams and Schirmer tear tests to be sure the medication is working. When treating other conditions, monitor your pet for improvement of clinical signs. Monitor your pet at home for serious side effects.

How do I store tacrolimus?

Store this medication at room temperature, protected from moisture and direct sunlight, unless otherwise directed on the label. Do not refrigerate or freeze.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.

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