Tacrolimus

INTRODUCTION

Indications

Oral, IV: Prevention of organ rejection in patients who have undergone allogenic liver, kidney, or heart transplantation (used concurrently with corticosteroids).

Topical: Moderate-to-severe atopic dermatitis in nonimmunocompromised patients who do not respond to or cannot tolerate alternative, conventional therapies.

Action

Inhibits T-lymphocyte activation. Therapeutic Effects: Prevention of transplanted organ rejection (oral, IV). Improvement in signs/symptoms of atopic dermatitis (topical).

Adverse Reactions/Side Effects

CNS: SEIZURES, dizziness, headache, insomnia, tremor, abnormal dreams, agitation, anxiety, confusion, emotional lability, depression, hallucinations, psychoses, somnolence. EENT: abnormal vision, amblyopia, tinnitus. Resp: cough, pleural effusion, asthma, bronchitis, pharyngitis, pneumonia, pulmonary edema. CV: hypertension, peripheral edema, QTc prolongation. GI: GI BLEEDING, abdominal pain, anorexia, ascites, constipation, diarrhea, dyspepsia, ↑ liver function studies, nausea, vomiting, cholangitis, cholestatic jaundice, dysphagia, flatulence, ↑ appetite, oral thrush. GU: nephrotoxicity, urinary tract infection. Derm: pruritus, rash, alopecia, herpes simplex, hirsutism, sweating, photosensitivity. Endo: hyperglycemia. F and E: hyperkalemia, hyperlipidemia, hypokalemia, hypomagnesemia, hypophosphatemia, hyperphosphatemia, hyperuricemia, hypocalcemia, hyponatremia, metabolic acidosis, metabolic alkalosis. Hemat: anemia, leukocytosis, leukopenia, thrombocytopenia, coagulation defects. MS: arthralgia, hypertonia, leg cramps, muscle spasm, myalgia, myasthenia, osteoporosis. Neuro: paresthesia, neuropathy. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, fever, generalized pain, abnormal healing, chills, ↑ risk of lymphoma/skin cancer.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.

• Be alert for signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Monitor signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools. Report these signs to the physician or nursing staff immediately.

• Assess any breathing problems or signs of pulmonary dysfunction (pneumonia, pulmonary edema, pleural effusion). Signs include cough, shortness of breath, chest pain, labored breathing, fever, and abnormal breath sounds. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any ECG abnormalities or signs of arrhythmias, ...