Patient leaflet - Tacrolimus Accord 0.1 % ointment

1. What Tacrolimus ointment is and what it is used for

The active substance of Tacrolimus ointment, tacrolimus monohydrate, is an immunomodulating agent.

Tacrolimus 0.1% ointment is used to treat moderate to severe atopic dermatitis (eczema) in adults who are not adequately responsive to or are intolerant of conventional therapies such as topical corticosteroids.

Once moderate to severe atopic dermatitis is cleared or almost cleared after up to 6 weeks treatment of a flare, and if you are experiencing frequent flares (i.e. 4 or more per year), it may be possible to prevent flares coming back or prolong the time you are free from flares by using Tacrolimus 0.1% ointment twice weekly.

In atopic dermatitis, an over-reaction of the skin’s immune system causes skin inflammation (itchiness, redness, dryness). Tacrolimus ointment alters the abnormal immune response and relieves the skin inflammation and the itch.

2. What you need to know before you use Tacrolimus ointment

Do not use Tacrolimus ointment

If you are allergic (hypersensitive) to tacrolimus or any of the other ingredients of Tacrolimus ointment (listed in section 6) or to macrolide antibiotics (e.g. azithromycin, clarithromycin, erythromycin).

Warnings and precautions

Talk to your doctor if you:

have liver failure
have any skin malignancies (tumours) or if you have a weakened immune system (immuno-compromised) whatever the cause.
have an inherited skin barrier disease such as Netherton’s syndrome, lamellar ichthyosis (extensive scaling of the skin due to a thickening of the outer layer of the skin), or if you have an inflammatory skin disease such as pyoderma gangrenosum, or if you suffer from generalised erythroderma (inflammatory reddening and scaling of the entire skin).
have a cutaneous Graft Versus Host Disease (an immune reaction of the skin which is a common complication in patients who have undergone a bone marrow transplant).
have swollen lymph nodes at initiation of treatment. If your lymph nodes become swollen during treatment with Tacrolimus ointment, consult your doctor
have infected lesions. Do not apply the ointment to infected lesions.
notice any change to the appearance of your skin, please inform your physician.
Based on the results of long-term studies and experience, a link between Tacrolimus ointment treatment and the development of malignancies has not been confirmed, but definitive conclusions cannot be drawn.
Avoid exposing the skin to long periods of sunlight or artificial sunlight such as tanning beds. If you spend time outdoors after applying Tacrolimus ointment, use a sunscreen and wear loose fitting clothing that protects the skin from the sun. In addition, ask your doctor for advice on other appropriate sun protection methods. If you are prescribed light therapy, inform your doctor that you are using Tacrolimus ointment as it is not recommended to use Tacrolimus ointment and light therapy at the same time.
If your doctor tells you to use Tacrolimus ointment twice weekly to keep your atopic dermatitis cleared, your condition should be reviewed by your doctor at least every 12 months, even if it remains under control. In children, maintenance treatment should be suspended after 12 months, to assess whether the need for continued treatment still exists.
Patients should be advised not to bathe, shower or swim immediately after applying the ointment; water may wash off the medicine.
It is recommended to use Tacrolimus ointment at the lowest possible strength, at the lowest frequency and for the shortest possible duration necessary. This decision should be based on your doctor’s assessment of how your eczema responds to Tacrolimus ointment.
Do not smoke or go near naked flames - risk of severe burns. Fabric (clothing, bedding, dressings etc.) that has been in contact with this product burns more easily and is a serious fire hazard. Washing clothing and bedding may reduce product build-up but not totally remove it.
Children
- Tacrolimus 0.1% ointment is not approved for children younger than 16 years of age. Therefore it should not be used in this age group. Please consult your doctor.
- The effect of treatment with Tacrolimus ointment on the developing immune system in children, especially the young, has not been established.

Other medicines, cosmetics and Tacrolimus ointment

Tell your doctor or pharmacist if you are taking or have recently used or might use any other medicines.

You may use moisturising creams and lotions during treatment with Tacrolimus ointment but these products should not be used within two hours of applying Tacrolimus ointment.

The use of tacrolimus at the same time as other preparations to be used on the skin or while taking oral corticosteroids (e.g. cortisone) or medicines which affect the immune system has not been studied.

Tacrolimus ointment with alcohol

While using Tacrolimus ointment, drinking alcohol may cause the skin or face to become flushed or red and feel hot.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before using this medicine.

3. How to use Tacrolimus ointment

Always use Tacrolimus ointment exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.

Apply Tacrolimus ointment as a thin layer to affected areas of your skin.
Tacrolimus ointment may be used on most parts of the body, including the face and neck and in the creases of your elbows and knees.
Avoid using the ointment inside your nose or mouth or in your eyes. If the ointment gets on any of these areas, it should be thoroughly wiped off and/or rinsed off with water.
Do not cover the skin being treated with bandages, wraps or other wound dressing.
Wash your hands after applying Tacrolimus ointment unless your hands are also being treated.
Before applying Tacrolimus ointment after a bath or shower, be sure your skin is completely dry.
Do not bathe, shower, or swim immediately after applying the ointment. Water may wash off the medicine.

Adults (16 years of age and older)

Two strengths of tacrolimus ointment (tacrolimus 0.03% ointment and tacrolimus 0.1% ointment) are available for adult patients (16 years of age and older). Your doctor will decide which strength is best for you.

Usually, treatment is started with Tacrolimus 0.1% ointment twice a day, once in the morning and once in the evening, until the eczema has cleared. Depending on the response of your eczema your doctor will decide if the frequency of application can be reduced or the lower strength, tacrolimus 0.03% ointment, can be used.

Treat each affected region of your skin until the eczema has gone away. Improvement is usually seen within one week. If you do not see any improvement after two weeks, see your doctor about other possible treatments.

You may be told by your doctor to use Tacrolimus 0.1% ointment twice weekly once your atopic dermatitis has cleared or almost cleared. Tacrolimus 0.1% ointment should be applied once a day twice weekly (e.g. Monday and Thursday) to areas of your body commonly affected by atopic dermatitis. There should be 2–3 days without Tacrolimus ointment treatment between applications.

If symptoms reappear you should use Tacrolimus ointment twice daily as outlined above and arrange to see your doctor to review your treatment.

If you accidentally swallow some ointment

If you accidentally swallow the ointment, consult your doctor or pharmacist as soon as possible. Do not try to induce vomiting.

If you forget to use Tacrolimus ointment

If you forget to apply the ointment at the scheduled time, do it as soon as you remember and then continue as before.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, Tacrolimus ointment can cause side effects, although not everybody gets them.

Very common (may affect more than 1 in 10 people):

burning sensation and itching

These symptoms are usually mild to moderate and generally go away within one week of using Tacrolimus ointment.

Common (may affect up to 1 in 10 people):

redness
feeling of warmth
pain
increased skin sensitivity (especially to hot and cold)
skin tingling
rash
local skin infection regardless of specific cause including but not limited to: inflamed or infected hair follicles, cold sores, generalised herpes simplex infections
facial flushing or skin irritation after drinking alcohol is also common

Uncommon (may affect fewer than 1 in 100 people):

acne

Following twice-weekly treatment application site infections have been reported in adults.

Rosacea (facial redness), rosacea-like dermatitis, lentigo (presence of flat brown spots on the skin), oedema at the application site and herpes eye infections have been reported during post-marketing experience.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme Website:

www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Tacrolimus ointment

Keep out of the sight and reach of children.

Do not use Tacrolimus ointment after the expiry date which is stated on the tube and carton after EXP. The expiry date refers to the last day of that month.

Do not store above 25ºC.

Discard open tubes 90 days after opening, even if they are not empty. They should not be kept for future use.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.

6. Contents of the pack and other information

What Tacrolimus ointment contains

The active substance is tacrolimus monohydrate.
One gram of Tacrolimus 0.1% ointment contains 1.0 mg tacrolimus (as tacrolimus monohydrate).
The other ingredients are paraffin, white soft; paraffin liquid; propylene carbonate; beeswax, white; paraffin hard.

What Tacrolimus ointment looks like and contents of the pack

Tacrolimus ointment is a white to slightly yellowish ointment. It is supplied in tubes containing 10, 30 or 60 grams of ointment. Not all pack sizes may be marketed.

Marketing Authorisation Holder

Accord Healthcare Limited

Sage House, 319 Pinner Road

North Harrow, Middlesex, HA1 4HF

United Kingdom

Manufacturer