Tacrolimus Ophthalmic

What is tacrolimus ophthalmic?

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 (extra label). Many drugs are commonly prescribed for off-label use in veterinary medicine. 

“Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. In these instances, follow your veterinarian’s directions and cautions carefully, as they may be significantly different from those on the label.

How is tacrolimus ophthalmic given?

• Tacrolimus ophthalmic is applied to the eye in the form of an ointment or liquid solution, usually twice daily.
• 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 before other eye medications.
• 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.
• Do not allow your pet to ingest this medication as it can be toxic when eaten.

Tacrolimus ophthalmic is considered a hazardous drug, so it is essential to avoid accidental exposure. Wear gloves when handling the medication and do not handle it if you are pregnant or nursing. If your pet vomits after receiving this drug, wear gloves while cleaning up.

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 as soon as you remember, and then continue with the regular dosing schedule. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not give the pet two doses at once.

Are there any potential side effects?

Tacrolimus ophthalmic may cause the following side effects:

• Mild irritation upon application
• Eyelid twitches
• Hair loss around the eye

Serious adverse reactions may occur. If any of the following signs develop, stop giving tacrolimus ophthalmic and contact your veterinarian immediately:

• Difficulty breathing
• Facial swelling
• Hives
• Weakness
• Tiredness

Drug sensitivities can develop over time, with repeated exposure. Your pet may have no reaction after the first few doses but may develop a sensitivity later. 

It is important to watch for signs of an allergic reaction over the entire course of treatment (e.g., irregular breathing, rash, fever, puffiness and swelling around the face) and notify your veterinarian if you have any concerns.

Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. This moderate-acting medication should stop working in a few days.

Are there any risk factors for this medication?

DO NOT USE tacrolimus ophthalmic in:

• Pets that are allergic to it
• Pets with a viral or fungal infection in the eye

USE WITH CAUTION in:

• Pets that are pregnant or nursing

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 before starting any new treatment.

Is any monitoring needed with this medication?

• When used to treat dry eye, your veterinarian will monitor your pet’s tear production through regular eye exams and Schirmer tear tests to be sure the medication is working.
• When used to treat other conditions, your veterinarian will let you know when and how they want to reassess your pet to ensure the medication is working and not causing side effects.
• At home, monitor your pet for improvement of clinical signs and monitor for any side effects such as those noted above. If any occur, stop using the medication and contact your veterinarian.

How do I store tacrolimus ophthalmic?

• Store this medication at room temperature, protected from moisture and direct sunlight, unless otherwise directed on the label.
• Do not refrigerate or freeze.
• Keep the container out of reach of children and pets.

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. Be prepared to provide information about the product and your pet’s weight and symptoms.