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Drug · FAERS side-effect profile with label screen

Tacrolimus side effects: what 155,699 FDA adverse event reports show

Tacrolimus · 1,396 reaction terms · 497,968 drug–reaction co-reports · data 2026-09-14
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Drug class

Calcineurin-inhibitor immunosuppressant

FDA label, Indications wording

Who reports

155,699 reports · 90% serious · 25,744 with death outcome · 44% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Tacrolimus capsule is a calcineurin-inhibitor immunosuppressant indicated for the prophylaxis of organ rejection in adult patients receiving allogeneic liver, kidney, or heart transplants, and pediatric patients receiving allogeneic liver transplants in combination with other immunosuppressants.

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

MALIGNANCIES AND SERIOUS INFECTIONS • Increased risk for developing serious infections and malignancies with tacrolimus or other immunosuppressants that may lead to hospitalization or death. ( 5.1 , 5.2 ) WARNING: MALIGNANCIES AND SERIOUS INFECTIONS See full prescribing information for complete boxed warning .

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 adverse reaction 5Labeled (related wording) 8Likely indication confounding 10Lab value / disease marker 1Not in label — unassessed 16
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). 1,356 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 transplantation1635,374.4
1,993.1–14,491.9ROR 5,380.0 · calibrated p 8e-19 ✓
127.8 EB05 112.2 · IC025 +6.3
3/3 methods agree
Labeled adverse reaction
exact term
serious n=163no trial arm names this drug
Malacoplakia341977.7
718.6–1,330.1ROR 979.8 · calibrated p 2e-16 ✓
116.3 EB05 106.3 · IC025 +6.5
3/3 methods agree
Not in label — unassessedserious n=337 · 100% clinicianno trial arm names this drug
Post transplant distal limb syndrome167611.8
426.8–877.0ROR 612.5 · calibrated p 4e-14 ✓
108.0 EB05 94.9 · IC025 +6.1
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=159 · 100% clinicianno trial arm names this drug
Trichodysplasia spinulosa301559.1
431.7–724.1ROR 560.2 · calibrated p 4e-14 ✓
106.8 EB05 97.1 · IC025 +6.3
3/3 methods agree
Not in label — unassessedserious n=267 · 100% clinicianno trial arm names this drug
Smooth muscle cell neoplasm330550.9
431.0–704.2ROR 552.1 · calibrated p 5e-14 ✓
106.6 EB05 97.3 · IC025 +6.3
3/3 methods agree
Not in label — unassessedserious n=327 · ♀ 79% (drug 44%) · 100% clinicianno trial arm names this drug
Polyomavirus-associated nephropathy1,817501.3
453.3–554.4ROR 507.2 · calibrated p 5e-14 ✓
105.1 EB05 101.1 · IC025 +6.6
3/3 methods agree
Labeled adverse reaction
exact term
serious n=1,817 · 97% clinicianno trial arm names this drug
Phaeohyphomycosis351453.8
364.1–565.8ROR 454.9 · calibrated p 3e-13 ✓
102.4 EB05 93.7 · IC025 +6.3
3/3 methods agree
Not in label — unassessedserious n=351 · 100% clinicianno trial arm names this drug
Delayed graft function540450.8
377.6–538.1ROR 452.3 · calibrated p 2e-13 ✓
102.4 EB05 95.4 · IC025 +6.4
3/3 methods agree
Not in label — unassessedserious n=540 · 92% clinicianno trial arm names this drug
Immunosuppressant drug level increased2,394368.4
340.8–398.3ROR 374.2 · calibrated p 1e-12 ✓
97.8 EB05 94.5 · IC025 +6.5
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious n=2,255no trial arm names this drug
Polyomavirus viraemia689304.9
266.2–349.3ROR 306.3 · calibrated p 9e-12 ✓
92.5 EB05 86.9 · IC025 +6.3
3/3 methods agree
Not in label — unassessedserious n=684 · 97% clinicianno trial arm names this drug
Chronic allograft nephropathy540299.2
256.9–348.5ROR 300.3 · calibrated p 1e-11 ✓
91.9 EB05 85.6 · IC025 +6.3
3/3 methods agree
Not in label — unassessedserious n=540 · 90% clinicianno trial arm names this drug
Donor specific antibody present101277.5
196.8–391.3ROR 277.7 · calibrated p 7e-11 ✓
88.6 EB05 75.0 · IC025 +5.6
3/3 methods agree
Lab value / disease markerserious n=101 · ♀ 100% (drug 44%) · 100% clinicianno trial arm names this drug
Immunosuppressant drug level decreased780260.4
230.8–293.9ROR 261.7 · calibrated p 4e-11 ✓
88.0 EB05 83.0 · IC025 +6.3
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious n=691no trial arm names this drug
Rhodococcus infection108249.9
181.3–344.4ROR 250.1 · calibrated p 1e-10 ✓
85.7 EB05 73.0 · IC025 +5.6
3/3 methods agree
Not in label — unassessedserious n=108 · ♀ 0% (drug 44%) · 100% clinicianno trial arm names this drug
Alternaria infection236245.1
197.5–304.1ROR 245.5 · calibrated p 1e-10 ✓
85.8 EB05 77.0 · IC025 +6.0
3/3 methods agree
Not in label — unassessedserious n=229 · 100% clinicianno trial arm names this drug
Transplant rejection5,029230.7
220.4–241.5ROR 238.4 · calibrated p 8e-11 ✓
84.5 EB05 82.6 · IC025 +6.3
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious PRR 54.4 · 92% clinicianno trial arm names this drug
Liver transplant rejection1,100211.2
192.0–232.3ROR 212.7 · calibrated p 2e-10 ✓
81.7 EB05 77.7 · IC025 +6.2
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious n=1,094no trial arm names this drug
Parvovirus b19 infection531206.6
180.3–236.7ROR 207.3 · calibrated p 3e-10 ✓
80.9 EB05 75.3 · IC025 +6.1
3/3 methods agree
Labeled adverse reaction
exact term
serious n=487 · 100% clinicianno trial arm names this drug
Heart transplant rejection619197.7
174.5–223.9ROR 198.5 · calibrated p 5e-10 ✓
79.5 EB05 74.4 · IC025 +6.1
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious n=617no trial arm names this drug
Complications of transplanted kidney1,319197.0
180.9–214.5ROR 198.7 · calibrated p 4e-10 ✓
79.5 EB05 76.0 · IC025 +6.2
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=1,314no trial arm names this drug
Cerebral nocardiosis121177.3
135.0–232.9ROR 177.5 · calibrated p 2e-9 ✓
75.3 EB05 64.7 · IC025 +5.6
3/3 methods agree
Not in label — unassessedserious n=121 · 100% clinicianno trial arm names this drug
Human herpesvirus 8 infection323153.8
131.0–180.6ROR 154.1 · calibrated p 4e-9 ✓
71.2 EB05 65.0 · IC025 +5.8
3/3 methods agree
Not in label — unassessedserious n=320 · 100% clinicianno trial arm names this drug
Pulmonary nocardiosis429149.7
130.4–171.9ROR 150.1 · calibrated p 5e-9 ✓
70.4 EB05 65.0 · IC025 +5.9
3/3 methods agree
Not in label — unassessedserious n=428 · 100% clinicianno trial arm names this drug
Acanthamoeba infection96137.6
103.4–183.2ROR 137.7 · calibrated p 2e-8 ✓
67.0 EB05 56.5 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious n=96 · ♀ 0% (drug 44%) · 100% clinicianno trial arm names this drug
Graft loss357128.3
110.9–148.4ROR 128.6 · calibrated p 2e-8 ✓
65.3 EB05 59.8 · IC025 +5.7
3/3 methods agree
Labeled adverse reaction
exact term
serious n=355 · 94% clinicianno trial arm names this drug
Complications of transplanted lung147125.9
100.4–157.8ROR 126.0 · calibrated p 3e-8 ✓
64.4 EB05 56.1 · IC025 +5.5
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=146no trial arm names this drug
Kidney transplant rejection2,312124.7
117.8–131.9ROR 126.5 · calibrated p 2e-8 ✓
64.5 EB05 62.4 · IC025 +5.9
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious n=2,306no trial arm names this drug
Complications of transplanted heart100116.7
89.2–152.7ROR 116.8 · calibrated p 6e-8 ✓
61.7 EB05 52.2 · IC025 +5.2
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=100 · ♀ 0% (drug 44%)no trial arm names this drug
Bk virus infection1,551116.6
108.9–124.8ROR 117.7 · calibrated p 3e-8 ✓
62.3 EB05 59.7 · IC025 +5.9
3/3 methods agree
Labeled adverse reaction
exact term
serious n=1,523 · 94% clinicianno trial arm names this drug
Pulmonary mucormycosis235113.1
95.0–134.6ROR 113.3 · calibrated p 5e-8 ✓
61.1 EB05 54.8 · IC025 +5.5
3/3 methods agree
Not in label — unassessedserious n=235 · 100% clinicianno trial arm names this drug
Disseminated mucormycosis176112.1
91.7–137.1ROR 112.3 · calibrated p 6e-8 ✓
60.7 EB05 53.5 · IC025 +5.5
3/3 methods agree
Not in label — unassessedserious n=176 · 100% clinicianno trial arm names this drug
Epstein-barr viraemia491111.3
98.7–125.5ROR 111.6 · calibrated p 5e-8 ✓
60.7 EB05 56.3 · IC025 +5.7
3/3 methods agree
Not in label — unassessedserious n=489 · 100% clinicianno trial arm names this drug

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 infection8,2008.68.4–8.8signal
Kidney injury15,7044.84.7–4.8signal
Interstitial lung disease1,8152.62.5–2.7signal
Serious infection14,1702.52.5–2.5signal
Neutropenia / agranulocytosis4,2472.32.3–2.4signal
Anaemia4,6272.12.0–2.2signal
Thrombocytopenia3,1882.01.9–2.0raised
Liver injury3,9561.81.7–1.8raised
Hyponatraemia9801.61.5–1.8raised
Pancreatitis9261.61.5–1.7raised
Hyperglycaemia / diabetes3,3471.31.3–1.4raised
Rhabdomyolysis / myopathy7341.21.1–1.3raised
Seizure1,6551.11.1–1.2raised
Gi bleeding1,4531.11.0–1.1raised
Venous thromboembolism1,6031.00.9–1.0no difference
Heart failure1,3231.00.9–1.1no difference

Trial evidence (ClinicalTrials.gov)

ClinicalTrials.gov returned results-bearing trials mentioning Tacrolimus only as a background or rescue medication (NCT01139450, NCT01950819); no trial listing it as the tested intervention was cached, so no trial cross-check is shown.

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)15,2002.4
2.3–2.4ROR 2.5 · calibrated p 0.799
2.4 EB05 2.3 · IC025 +1.2
3/3 methods agree
Reporting / coding artifactage-adj. PRR 2.0 · serious PRR 2.5no trial arm names this drug
Drug ineffective (drug did not work)10,3351.1
1.0–1.1ROR 1.1 · calibrated p 0.347
1.1 EB05 1.0 · IC025 +0.0Reporting / coding artifactage-adj. PRR 1.3 · serious PRR 1.7no trial arm names this drug
Drug interaction6,4285.6
5.5–5.8ROR 5.8 · calibrated p 0.160
5.5 EB05 5.3 · IC025 +2.4
3/3 methods agree
Reporting / coding artifactage-adj. PRR 5.0 · serious PRR 3.7 · 93% clinicianno trial arm names this drug
Product use in unapproved indication6,3643.6
3.5–3.7ROR 3.7 · calibrated p 0.441
3.5 EB05 3.4 · IC025 +1.8
3/3 methods agree
Reporting / coding artifactage-adj. PRR 3.2 · serious PRR 4.4 · 91% clinicianno trial arm names this drug
Diarrhoea (diarrhea)5,9521.2
1.2–1.3ROR 1.3 · calibrated p 0.480
1.2 EB05 1.2 · IC025 +0.3Labeled adverse reaction
exact term
age-adj. PRR 1.2 · serious PRR 1.3no trial arm names this drug
Death5,0370.8
0.8–0.8ROR 0.8 · calibrated p 0.172
0.8 EB05 0.8 · IC025 -0.4
PRR-only: not supported by EBGM or IC
Outcome field, not a reaction
boxed warning mentions mortality
age-adj. PRR 0.9 · serious PRR 0.5no trial arm names this drug
Transplant rejection5,029230.7
220.4–241.5ROR 238.4 · calibrated p 8e-11 ✓
84.5 EB05 82.6 · IC025 +6.3
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious PRR 54.4 · 92% clinicianno trial arm names this drug
Cytomegalovirus infection4,65552.2
50.5–54.0ROR 53.8 · calibrated p 8e-6 ✓
37.7 EB05 36.8 · IC025 +5.2
3/3 methods agree
Labeled adverse reaction
exact term
age-adj. PRR 38.5 · serious PRR 24.1 · 94% clinicianno trial arm names this drug
Pneumonia (lung infection)4,5641.9
1.9–2.0ROR 1.9 · calibrated p 0.912
1.9 EB05 1.9 · IC025 +0.9Labeled — boxed warning
synonym match
age-adj. PRR 1.8 · serious PRR 1.3no trial arm names this drug
Covid-193,9673.1
3.0–3.2ROR 3.1 · calibrated p 0.588
3.0 EB05 2.9 · IC025 +1.5
3/3 methods agree
Not in label — unassessedage-adj. PRR 2.8 · serious PRR 3.2 · 90% clinicianno trial arm names this drug
Toxicity to various agents3,8793.2
3.1–3.3ROR 3.2 · calibrated p 0.560
3.1 EB05 3.0 · IC025 +1.6
3/3 methods agree
Not in label — unassessedage-adj. PRR 2.4 · serious PRR 2.0 · 92% clinicianno trial arm names this drug
Renal impairment3,7036.2
6.0–6.4ROR 6.3 · calibrated p 0.131
6.0 EB05 5.8 · IC025 +2.5
3/3 methods agree
Labeled adverse reaction
exact term
age-adj. PRR 6.5 · serious PRR 3.9no trial arm names this drug
Sepsis (blood infection)3,5404.4
4.2–4.5ROR 4.5 · calibrated p 0.302
4.3 EB05 4.2 · IC025 +2.0
3/3 methods agree
Labeled — boxed warning
synonym match
age-adj. PRR 3.9 · serious PRR 2.7 · 91% clinicianno trial arm names this drug

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?

In FDA FAERS, the most frequently co-reported reaction terms for Tacrolimus are acute kidney injury, diarrhoea, transplant rejection, pyrexia, cytomegalovirus infection, pneumonia. 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 have an FDA boxed warning?

Yes. The current FDA label carries a boxed warning: MALIGNANCIES AND SERIOUS INFECTIONS • Increased risk for developing serious infections and malignancies with tacrolimus or other immunosuppressants that may lead to hospitalization or death. ( 5.1 , 5.2 ) WARNING: MALIGNANCIES AND SERIOUS INFECTIONS See full prescribing information for complete boxed warning .

Do FAERS signals prove that Tacrolimus 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.