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Tacrolimus topical Side Effects

In Summary

Commonly reported side effects of tacrolimus topical include: burning sensation of skin and pruritus. Other side effects include: herpes zoster, varicella zoster infection, and vesicobullous dermatitis. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to tacrolimus topical: topical ointment

As well as its needed effects, tacrolimus topical may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking tacrolimus topical, check with your doctor immediately:

Incidence not known:
  • Agitation
  • black, tarry stools
  • bloody urine
  • burning or stinging sensation of the face
  • change in size, shape, or color of an existing mole
  • coma
  • confusion
  • convulsions
  • decreased frequency or amount of urine
  • depression
  • fever
  • general feeling of illness
  • growth or bump on skin
  • hostility
  • increase in bone pain
  • increased blood pressure
  • increased thirst
  • irritability
  • lethargy
  • looks very ill
  • loss of appetite
  • loss of bladder control
  • lower back or side pain
  • mole that leaks fluid or bleeds
  • muscle spasm or jerking of all extremities
  • muscle twitching
  • nausea
  • new mole
  • rapid weight gain
  • red rash with watery, yellow-colored, or pus filled blisters
  • redness of the face
  • seizures
  • small, red skin lesion, growth, or bump usually on the face, ears, neck, hands, or arms
  • sore that will not heal
  • spider-like blood vessels on the face
  • stupor
  • sudden loss of consciousness
  • swelling of the face, ankles, lower legs, hands, or fingers
  • swollen glands
  • thick, yellow to honey-colored crusts
  • unusual tiredness or weakness
  • vomiting
  • weight gain
  • weight loss
  • yellow skin and eyes

Minor Side Effects

Some tacrolimus topical side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common:
  • Cough
  • fever
  • general aches and pains
  • headache
  • itching skin—in children
  • loss of appetite
  • skin burning
  • skin flushing in areas of ointment application when drinking alcohol
  • sneezing
  • weakness
Less common:
  • Acid or sour stomach
  • acne
  • back pain
  • belching
  • burning, itching, or pain in hairy areas
  • chills
  • cyst
  • flushing
  • heartburn
  • increased sensitivity to sunlight
  • increased skin sensitivity
  • indigestion
  • itching eyes
  • joint pain
  • muscle aches or pain
  • pain in the eye
  • pain or tenderness around the eyes and cheekbones
  • pus at root of the hair
  • rash
  • redness in the eye
  • runny nose
  • severe skin rash or hives
  • skin blisters—in children
  • skin tingling
  • stomach discomfort, upset, or pain
  • stuffy nose
  • swelling of the eye, eyelid, or inner lining of the eyelid
  • swollen glands
  • tightness of the chest
  • troubled breathing or wheezing
  • watery eyes

For Healthcare Professionals

Applies to tacrolimus topical: topical ointment


Dermatologic effects have included skin burning (46% to 58%), pruritus (25% to 46%), skin erythema (12% to 28%), skin infection (5% to 12%), herpes simplex (4% to 12%), folliculitis (4% to 11%), pustular rash (3% to 6%), dry skin (3%), hyperesthesia (3% to 7%), urticaria (3% to 6%), skin tingling (2% to 8%), acne (2% to 7%), rash (2% to 5%), maculopapular rash (2% to 4%), vesiculobullous rash (2% to 4%), eczema (2% to 3%), sunburn (1% to 4%), skin disorder (1% to 4%), contact dermatitis (1% to 3%), exfoliative dermatitis (1% to 3%), fungal dermatitis (1% to 2%), eczema herpeticum (1% to 2%), benign skin neoplasm (1% to 2%), and varicella zoster/herpes zoster (1%). Other dermatologic side effects have included facial flushing, ecchymosis, cellulitis, skin discoloration, alopecia, angioedema, and sweating.[Ref]


Oncologic side effects have included lymphoma and skin cancer. A definite causal relationship between these effects and tacrolimus topical has not been clearly established.[Ref]

As of December 2004, nineteen postmarketing cases of cancer in patients receiving treatment with tacrolimus topical have been reported to the FDA MedWatch program. Ten cases were reported as cutaneous tumors (7 at site of application), 9 cases as lymphomas, and the remaining as a variety of tumors (including squamous cell carcinoma, cutaneous sarcoma, and malignant melanoma). Three of these cases were reported to have occurred in children, with the remaining 16 cases reported in adults. In addition, 6 of the cases reported lymphadenopathy. The median time to diagnosis was 150 days (range 21 to 790 days) following initiation of treatment with tacrolimus topical. Two deaths were reported in adults and 8 patients were hospitalized (6 adults, 2 children). Causality has not been established.[Ref]


Gastrointestinal side effects have included diarrhea (3% to 4%), gastroenteritis (2% to 4%), nausea (1% to 4%), dyspepsia (1% to 4%), abdominal pain (1% to 3%), and vomiting (1%). Other gastrointestinal side effects have included taste perversion, anorexia, and constipation.[Ref]


Musculoskeletal side effects have included back pain (2% to 3%), asthenia (2% to 3%), and myalgia (1% to 3%). Other musculoskeletal side effects have included arthritis, arthralgia, and neck pain.[Ref]


Respiratory side effects have included asthma (4% to 6%), pharyngitis (3% to 5%), rhinitis (3% to 5%), sinusitis (2% to 5%), bronchitis (2% to 3%), increased cough (1% to 3%), and pneumonia (1%). Other respiratory side effects have included dyspnea, hypoxia, and lung disorder.[Ref]

Nervous system

Nervous system side effects have included headache (10% to 20%), and insomnia (1% to 4%). Other nervous system side effects have included dizziness, anxiety, migraine, neuritis, and paresthesia.[Ref]


Metabolic side effects have included increased ALT, AST, increased creatinine, hyperglycemia, hypoglycemia, and bilirubinuria.[Ref]


Ocular side effects have included conjunctivitis (2% to 4%). Other ocular side effects have included eye pain and eye disorder.[Ref]


Immunologic symptoms have included flu like symptoms (22% to 31%), infection (1% to 14%), fever (1% to 4%), lymphadenopathy (1% to 3%), and periodontal abscess (1% to 3%). Other immunologic side effects have included leukocytosis and leukopenia.[Ref]


Cardiovascular side effects have included peripheral edema (2% to 4%). Other cardiovascular side effects have included angina pectoris, cerebrovascular accident, peripheral vascular disorder, arrhythmias, palpitations, hypertension, and vasodilation.[Ref]


General side effects have included lack of drug effect (1% to 10%), accidental injury (3% to 6%), alcohol intolerance (2% to 7%), facial edema (1% to 3%), pain (1% to 4%), and cyst (1% to 3%). Other general side effects have included chills, and increased dehydration.[Ref]


Other side effects have included otitis media (1%) and ear pain.[Ref]


Genitourinary side effects have included dysmenorrhea (2% to 4%). Other genitourinary side effects have included unintended pregnancy and vaginal moniliasis.[Ref]


Local side effects have included exacerbation of the untreated area and postmarketing reports of application site edema.[Ref]


Hepatic side effects have included liver function test abnormalities.[Ref]


Psychiatric side effects have included depression.[Ref]


Hematologic side effects have included epistaxis.[Ref]


1. Milingou M, Antille C, Sorg O, Saurat JH, Lubbe J "Alcohol intolerance and facial flushing in patients treated with topical tacrolimus." Arch Dermatol 140 (2004): 1542-4

2. "Product Information. Protopic (tacrolimus topical)" Fujisawa, Deerfield, IL.

3. Simpson D, Noble S "Tacrolimus ointment: a review of its use in atopic dermatitis and its clinical potential in other inflammatory skin conditions." Drugs 65 (2005): 827-58

4. FDA. U.S. Food and Drug Administration. Center for Drug Evaluation and Research "Protopic ointment (tacrolimus)information. FDA Alert. Available from: URL:" ([2005 Feb 14]):

It is possible that some side effects of tacrolimus topical may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.