Treatments

Tacrolimus

Tacrolimus is one of the second-line immunosuppressive agents used in the treatment of non-infectious uveitis. The medication lowers the inflammation in the body and reduces the immune system activity by the decreasing the development and proliferation of T lymphocytes (one of the body’s main types of immune cells constituting the immune system).

Tacrolimus is usually prescribed in the following situations:

When the dose of prednisolone to maintain the quiescence of uveitis is unacceptable because high (>7.5mg/day maintenance)
When recurrent high doses of steroids are needed for relapsing disease  
When the use of immunosuppressive therapy is needed at presentation due to severity of uveitis
When a steroid-sparing agent is needed due to prednisolone side effects

therapy

Tacrolimus is usually taken daily, in two doses. It should be taken on an empty stomach, either one hour before or three hours after meals.

Avoid grapefruit juice while taking the drug as this interferes with the drug.

The dose prescribed depends on patient’s body weight and severity of the disease.

For it to work well, the medication should be taken regularly.

Patients should not be discouraged if the results are not immediate, because the drug takes up to three weeks to become effective on the uveitis.

A reasonably long period of therapy (2 years) is usually required as maintenance therapy in most cases. However, tacrolimus does not help everyone who takes it and in some patients the condition might not improve.

Side effects

The use of tacrolimus can be associated with side effects. Not everyone will develop side effects from the use of the medication and presence of side effects varies from person to person. Potential side effects include:

Gastrointestinal symptoms (abdominal pain, nausea, diarrhoea, vomiting)
Tachycardia, angina
Hypertension (high blood pressure)
Leukopenia and thrombocytopenia (reduction in the level of certain blood cells) - patients should be warned to report immediately any infections, fever and inexplicable bruising or bleeding  
Renal or liver impairment

Hyperglycaemia (high blood sugar)
Hypomagnesaemia (low blood magnesium)
Headache
Tremors
Increase risk of lymphoma and skin cancers - avoid exposure to UV and strong sunlight, use sun block, long sleeves, etc.

If patients experience side effects after taking tacrolimus, they should report them immediately to the doctor.

Most side effects should improve when reducing the dosage or eventually stop the medication.

Certain medical conditions contraindicate the use of tacrolimus, including:

Other conditions required cautions in the administration of the drug. The doctor needs to be informed in case of:

Patients should inform the doctor about any medications they have been taken, due to potential risk of tacrolimus interaction with other drugs, and about allergy to medications.

Viral infections and vaccinations

As tacrolimus reduce the ability of the immune system to fight infections, patients on treatment are more likely to catch infections of the skin, mouth, stomach, intestines, lungs and urinary tract. Patients should report symptoms of infections to the doctor.

Patients should avoid live vaccines while on tacrolimus , including yellow fever, rubella and MMR. It is safe to have the flu vaccination and Pneumovax as they are not live vaccines.