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Tacrolimus Ointment 0.1% side effects: what 123,785 FDA adverse event reports show

Tacrolimus Ointment 0.1% · Tacrolimus · 1,412 reaction terms · 400,847 drug–reaction co-reports · data 2026-09-14
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Drug class

Not stated in label

Brand names

Tacrolimus

openFDA label

Who reports

123,785 reports · 90% serious · 19,724 with death outcome · 43% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Tacrolimus ointment, both 0.03% and 0.1% for adults, and only 0.03% for children aged 2 to 15 years, is indicated as second-line therapy for the short-term and non-continuous chronic treatment of moderate to severe atopic dermatitis in non-immunocompro.

FDA label, Indications and Usage

What it is

Tacrolimus (anhydrous) is a macrolide lactam containing a 23-membered lactone ring, originally isolated from the fermentation broth of a Japanese soil sample that contained the bacteria Streptomyces tsukubaensis.

PubChem CID 445643 (ChEBI)

Boxed warning

Long-term Safety of Topical Calcineurin Inhibitors Has Not Been Established Although a causal relationship has not been established, rare cases of malignancy (e.g., skin and lymphoma) have been reported in patients treated with topical calcineurin inhibitors, including tacrolimus ointment.

FDA label
How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Labeled (related wording) 2Lab value / disease marker 3Not in label — unassessed 35
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only (and, for the 300 most-reported drugs, adjusted for age band), and flags pairs whose reports are unusually skewed by sex or come mostly from consumers. Each row also shows the PRR against the other drugs of the same FDA class, which removes most confounding by the condition being treated, and a calibrated p-value: on validation, known non-causes average an ROR of about 2, so significance is judged against that empirical null (✓ = p < 0.05 after calibration). 1,372 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
New onset diabetes after transplantation1501,465.9
887.8–2,420.7ROR 1,467.7 · calibrated p 2e-17 ✓
147.3 EB05 128.6 · IC025 +6.4
3/3 methods agree
Not in label — unassessedserious n=150not reported in cached trials
Malacoplakia3341,047.0
783.6–1,398.9ROR 1,049.8 · calibrated p 6e-17 ✓
143.1 EB05 130.7 · IC025 +6.7
3/3 methods agree
Not in label — unassessedserious n=330 · 100% cliniciannot reported in cached trials
Transplantation associated food allergy85882.6
517.4–1,505.7ROR 883.2 · calibrated p 8e-15 ✓
136.4 EB05 113.8 · IC025 +5.9
3/3 methods agree
Not in label — unassessedserious n=85 · 100% cliniciannot reported in cached trials
Smooth muscle cell neoplasm325642.8
505.7–817.0ROR 644.5 · calibrated p 9e-15 ✓
131.8 EB05 120.2 · IC025 +6.6
3/3 methods agree
Not in label — unassessedserious n=322 · ♀ 80% (drug 43%) · 100% cliniciannot reported in cached trials
Renal graft infection181626.5
455.8–861.2ROR 627.4 · calibrated p 2e-14 ✓
130.3 EB05 115.1 · IC025 +6.4
3/3 methods agree
Not in label — unassessedserious n=181not reported in cached trials
Trichodysplasia spinulosa294626.2
487.9–803.7ROR 627.7 · calibrated p 1e-14 ✓
131.0 EB05 118.9 · IC025 +6.6
3/3 methods agree
Not in label — unassessedserious n=260 · ♀ 63% (drug 43%) · 96% cliniciannot reported in cached trials
Phaeohyphomycosis347543.9
437.6–676.0ROR 545.4 · calibrated p 4e-14 ✓
127.1 EB05 116.3 · IC025 +6.6
3/3 methods agree
Not in label — unassessedserious n=347 · 100% cliniciannot reported in cached trials
Post transplant distal limb syndrome152495.2
360.6–679.9ROR 495.8 · calibrated p 2e-13 ✓
123.2 EB05 107.7 · IC025 +6.2
3/3 methods agree
Not in label — unassessedserious n=145 · 93% cliniciannot reported in cached trials
Polyomavirus-associated nephropathy1,692466.2
424.9–511.5ROR 472.6 · calibrated p 1e-13 ✓
123.1 EB05 118.2 · IC025 +6.8
3/3 methods agree
Not in label — unassessedserious n=1,692 · 97% cliniciannot reported in cached trials
Delayed graft function481368.3
313.8–432.2ROR 369.7 · calibrated p 2e-12 ✓
114.7 EB05 106.3 · IC025 +6.5
3/3 methods agree
Not in label — unassessedserious n=481 · 91% cliniciannot reported in cached trials
Polyomavirus viraemia669349.5
305.9–399.4ROR 351.4 · calibrated p 2e-12 ✓
112.9 EB05 105.9 · IC025 +6.6
3/3 methods agree
Not in label — unassessedserious n=664 · 97% cliniciannot reported in cached trials
Rhodococcus infection106298.5
217.1–410.4ROR 298.7 · calibrated p 3e-11 ✓
105.4 EB05 89.6 · IC025 +5.8
3/3 methods agree
Not in label — unassessedserious n=106 · 100% cliniciannot reported in cached trials
Alternaria infection227277.3
224.2–343.0ROR 277.8 · calibrated p 3e-11 ✓
103.6 EB05 92.8 · IC025 +6.2
3/3 methods agree
Not in label — unassessedserious n=220 · 100% cliniciannot reported in cached trials
Parvovirus b19 infection517243.3
212.6–278.6ROR 244.3 · calibrated p 8e-11 ✓
99.0 EB05 92.0 · IC025 +6.4
3/3 methods agree
Not in label — unassessedserious n=473 · 100% cliniciannot reported in cached trials
Chronic allograft nephropathy462242.9
210.5–280.2ROR 243.8 · calibrated p 8e-11 ✓
98.9 EB05 91.5 · IC025 +6.3
3/3 methods agree
Not in label — unassessedserious n=462 · 92% cliniciannot reported in cached trials
Post transplant lymphoproliferative disorder2,896233.7
220.9–247.2ROR 239.3 · calibrated p 8e-11 ✓
97.6 EB05 94.7 · IC025 +6.5
3/3 methods agree
Not in label — unassessedserious n=2,891 · 98% cliniciannot reported in cached trials
Donor specific antibody present87233.1
168.3–322.9ROR 233.3 · calibrated p 3e-10 ✓
95.6 EB05 79.9 · IC025 +5.6
3/3 methods agree
Lab value / disease markerserious n=87 · ♀ 100% (drug 43%) · 100% cliniciannot reported in cached trials
Immunosuppressant drug level increased1,838216.1
201.7–231.6ROR 219.4 · calibrated p 2e-10 ✓
94.4 EB05 90.8 · IC025 +6.4
3/3 methods agree
Lab value / disease markerserious n=1,750not reported in cached trials
Human polyomavirus infection286209.3
175.9–249.1ROR 209.8 · calibrated p 3e-10 ✓
92.6 EB05 84.0 · IC025 +6.1
3/3 methods agree
Not in label — unassessedserious n=271 · 93% cliniciannot reported in cached trials
Cerebral nocardiosis116202.9
154.7–266.1ROR 203.1 · calibrated p 7e-10 ✓
90.6 EB05 77.5 · IC025 +5.7
3/3 methods agree
Not in label — unassessedserious n=116 · 100% cliniciannot reported in cached trials
Pancreas transplant rejection110200.8
152.1–265.1ROR 201.0 · calibrated p 8e-10 ✓
90.1 EB05 76.8 · IC025 +5.7
3/3 methods agree
Not in label — unassessedserious n=110 · ♀ 100% (drug 43%)not reported in cached trials
Human herpesvirus 8 infection315183.6
156.5–215.5ROR 184.1 · calibrated p 1e-9 ✓
87.3 EB05 79.5 · IC025 +6.1
3/3 methods agree
Not in label — unassessedserious n=312 · 100% cliniciannot reported in cached trials
Pulmonary nocardiosis418178.5
155.5–204.9ROR 179.1 · calibrated p 1e-9 ✓
86.2 EB05 79.5 · IC025 +6.1
3/3 methods agree
Not in label — unassessedserious n=417 · 100% cliniciannot reported in cached trials
Transplant rejection4,073176.6
169.1–184.5ROR 182.6 · calibrated p 9e-10 ✓
86.1 EB05 83.9 · IC025 +6.4
3/3 methods agree
Not in label — unassessedserious PRR 55.1 · 94% cliniciannot reported in cached trials
Transplant dysfunction891174.8
159.1–192.0ROR 176.0 · calibrated p 1e-9 ✓
85.5 EB05 80.9 · IC025 +6.2
3/3 methods agree
Not in label — unassessedserious n=891 · 91% cliniciannot reported in cached trials
Cytomegalovirus syndrome82170.3
125.2–231.7ROR 170.4 · calibrated p 4e-9 ✓
83.0 EB05 69.0 · IC025 +5.4
3/3 methods agree
Not in label — unassessedserious n=82 · 100% cliniciannot reported in cached trials
Complications of transplanted kidney1,074158.2
145.5–171.9ROR 159.6 · calibrated p 3e-9 ✓
81.4 EB05 77.4 · IC025 +6.2
3/3 methods agree
Not in label — unassessedserious n=1,070not reported in cached trials
Epidermodysplasia verruciformis80156.4
115.2–212.2ROR 156.5 · calibrated p 7e-9 ✓
79.6 EB05 66.0 · IC025 +5.4
3/3 methods agree
Not in label — unassessedserious n=79 · 100% cliniciannot reported in cached trials
Acanthamoeba infection90152.6
114.6–203.1ROR 152.7 · calibrated p 8e-9 ✓
78.7 EB05 66.0 · IC025 +5.5
3/3 methods agree
Not in label — unassessedserious n=90 · ♀ 0% (drug 43%) · 100% cliniciannot reported in cached trials
Heart transplant rejection494152.6
135.0–172.3ROR 153.2 · calibrated p 4e-9 ✓
79.8 EB05 74.0 · IC025 +6.1
3/3 methods agree
Not in label — unassessedserious n=492not reported in cached trials
Disseminated blastomycosis79150.9
111.3–204.6ROR 151.0 · calibrated p 9e-9 ✓
78.1 EB05 64.7 · IC025 +5.4
3/3 methods agree
Not in label — unassessedserious n=79 · ♀ 0% (drug 43%) · 100% cliniciannot reported in cached trials
Pulmonary mucormycosis232139.2
116.9–165.7ROR 139.4 · calibrated p 1e-8 ✓
75.7 EB05 67.9 · IC025 +5.8
3/3 methods agree
Not in label — unassessedserious n=232 · 100% cliniciannot reported in cached trials
Disseminated mucormycosis171134.0
109.6–163.9ROR 134.2 · calibrated p 2e-8 ✓
74.0 EB05 65.2 · IC025 +5.7
3/3 methods agree
Not in label — unassessedserious n=171 · 100% cliniciannot reported in cached trials
Epstein-barr viraemia469129.0
114.4–145.5ROR 129.5 · calibrated p 2e-8 ✓
72.8 EB05 67.5 · IC025 +5.9
3/3 methods agree
Not in label — unassessedserious n=467 · 100% cliniciannot reported in cached trials
Immunosuppressant drug level decreased513128.7
114.7–144.5ROR 129.3 · calibrated p 2e-8 ✓
72.8 EB05 67.6 · IC025 +5.9
3/3 methods agree
Lab value / disease markerserious n=467not reported in cached trials
Complications of transplanted lung131128.0
101.9–160.8ROR 128.2 · calibrated p 2e-8 ✓
72.0 EB05 62.2 · IC025 +5.5
3/3 methods agree
Not in label — unassessedserious n=130 · 91% cliniciannot reported in cached trials
Human ehrlichiosis86127.6
96.3–169.0ROR 127.7 · calibrated p 3e-8 ✓
71.5 EB05 59.7 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious n=85 · 100% cliniciannot reported in cached trials
Chronic graft versus host disease in eye84125.7
94.7–166.9ROR 125.8 · calibrated p 3e-8 ✓
70.9 EB05 59.0 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious n=84 · ♀ 0% (drug 43%)not reported in cached trials

Clinical concept groups

MedDRA splits one clinical problem across several terms (e.g. "neutropenia", "neutrophil count decreased", "agranulocytosis"), which dilutes term-level signals. These rows count reports with any term in a concept group (an exact union, not a sum), compared with all other drugs. Groups are hand-built and listed in the methods.

ConceptReportsPRR 95% CIReading
Opportunistic infection7,1099.39.1–9.5signal
Kidney injury12,2204.64.6–4.7signal
Serious infection11,3722.52.5–2.6signal
Interstitial lung disease1,3452.42.3–2.5signal
Neutropenia / agranulocytosis3,3822.32.3–2.4signal
Anaemia3,4892.01.9–2.0raised
Thrombocytopenia2,4581.91.8–2.0raised
Liver injury3,0601.71.7–1.8raised
Hyponatraemia7241.51.4–1.6raised
Pancreatitis6671.41.3–1.5raised
Rhabdomyolysis / myopathy5691.21.1–1.3raised
Hyperglycaemia / diabetes2,3411.11.1–1.2raised
Seizure1,1951.01.0–1.1no difference
Gi bleeding1,0891.01.0–1.1no difference
Venous thromboembolism1,1760.90.9–1.0lower than other drugs
Arrhythmia / qt9990.90.8–0.9lower than other drugs

Trial evidence (ClinicalTrials.gov)

✓ Trial adverse-event data found on ClinicalTrials.gov

Largest completed trials with posted results that list Tacrolimus Ointment 0.1% as a study intervention. The right-hand column of the signal table shows whether each FAERS term was also recorded in these trials, with a real denominator (0 of 40 signal terms matched).

Caveats: trial populations, doses and follow-up differ from the reporting population; AE terms are sponsor-coded and matched here by wording; absence from a trial list means the term was not reported above the sponsor's frequency threshold, not that it cannot occur.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Off label use (used outside approved label)12,6422.5
2.4–2.5ROR 2.7 · calibrated p 0.748
2.5 EB05 2.4 · IC025 +1.3
3/3 methods agree
Reporting / coding artifactage-adj. PRR 2.1 · serious PRR 2.6not reported in cached trials
Drug ineffective (drug did not work)8,8121.1
1.1–1.2ROR 1.1 · calibrated p 0.403
1.1 EB05 1.1 · IC025 +0.1Reporting / coding artifactage-adj. PRR 1.3 · serious PRR 1.8 · 91% cliniciannot reported in cached trials
Product use in unapproved indication6,0564.3
4.2–4.4ROR 4.4 · calibrated p 0.303
4.2 EB05 4.1 · IC025 +2.0
3/3 methods agree
Reporting / coding artifactage-adj. PRR 3.7 · serious PRR 5.2 · 92% cliniciannot reported in cached trials
Drug interaction5,5496.1
5.9–6.3ROR 6.3 · calibrated p 0.129
5.9 EB05 5.8 · IC025 +2.5
3/3 methods agree
Reporting / coding artifactage-adj. PRR 5.3 · serious PRR 4.0 · 95% cliniciannot reported in cached trials
Diarrhoea (diarrhea)4,4931.2
1.2–1.2ROR 1.2 · calibrated p 0.434
1.2 EB05 1.2 · IC025 +0.2Labeled adverse reaction
exact term
age-adj. PRR 1.2 · serious PRR 1.2not reported in cached trials
Transplant rejection4,073176.6
169.1–184.5ROR 182.6 · calibrated p 9e-10 ✓
86.1 EB05 83.9 · IC025 +6.4
3/3 methods agree
Not in label — unassessedserious PRR 55.1 · 94% cliniciannot reported in cached trials
Cytomegalovirus infection4,01053.7
51.8–55.6ROR 55.5 · calibrated p 7e-6 ✓
40.8 EB05 39.8 · IC025 +5.3
3/3 methods agree
Not in label — unassessedage-adj. PRR 38.0 · serious PRR 25.9 · 95% cliniciannot reported in cached trials
Covid-193,7203.6
3.5–3.7ROR 3.7 · calibrated p 0.439
3.6 EB05 3.5 · IC025 +1.8
3/3 methods agree
Not in label — unassessedage-adj. PRR 3.3 · serious PRR 3.8 · 91% cliniciannot reported in cached trials
Toxicity to various agents3,6153.7
3.6–3.8ROR 3.8 · calibrated p 0.419
3.6 EB05 3.5 · IC025 +1.8
3/3 methods agree
Not in label — unassessedage-adj. PRR 2.8 · serious PRR 2.4 · 94% cliniciannot reported in cached trials
Pneumonia (lung infection)3,5351.9
1.8–1.9ROR 1.9 · calibrated p 0.881
1.9 EB05 1.8 · IC025 +0.8Labeled — boxed warning
synonym match
age-adj. PRR 1.8 · serious PRR 1.2not reported in cached trials
Death3,3780.7
0.6–0.7ROR 0.7 · calibrated p 0.108
0.7 EB05 0.6 · IC025 -0.6
PRR-only: not supported by EBGM or IC
Outcome field, not a reactionage-adj. PRR 0.7 · serious PRR 0.4not reported in cached trials
Post transplant lymphoproliferative disorder2,896233.7
220.9–247.2ROR 239.3 · calibrated p 8e-11 ✓
97.6 EB05 94.7 · IC025 +6.5
3/3 methods agree
Not in label — unassessedserious n=2,891 · 98% cliniciannot reported in cached trials
Sepsis (blood infection)2,8564.4
4.3–4.6ROR 4.5 · calibrated p 0.296
4.3 EB05 4.2 · IC025 +2.1
3/3 methods agree
Not in label — unassessedage-adj. PRR 3.8 · serious PRR 2.8 · 93% cliniciannot reported in cached trials

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

✓ A hand-written Bradford Hill causality assessment exists for this drug: Tacrolimus ↔ Nephrotoxicity.

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Tacrolimus Ointment 0.1%?

In FDA FAERS, the most frequently co-reported reaction terms for Tacrolimus Ointment 0.1% are acute kidney injury, diarrhoea, transplant rejection, cytomegalovirus infection, pyrexia, covid-19. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Tacrolimus Ointment 0.1% have an FDA boxed warning?

Yes. The current FDA label carries a boxed warning: Long-term Safety of Topical Calcineurin Inhibitors Has Not Been Established Although a causal relationship has not been established, rare cases of malignancy (e.g., skin and lymphoma) have been reported in patients treated with topical calcineurin inhibitors, including tacrolimus ointment.

Do FAERS signals prove that Tacrolimus Ointment 0.1% causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-14. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.