Topical Calcineurin Inhibitors

Pimecrolimus and Tacrolimus belong to a group known as topical calcineurin inhibitors (TCI).

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What is this medication for?

Topical calcineurin inhibitor is used to treat eczema (atopic dermatitis) by acting on the skin immune system to reduce inflammation, redness and itching of the skin. 
Some examples of topical calcineurin inhibitor include Pimecrolimus and Tacrolimus.
This medicine is also used for other conditions as determined by your doctor.

How should I use this medication?

  • 1. Wash your skin with cleanser, rinse and pat dry
    2. Wash your hands before applying
    3. Apply your moisturiser after washing and drying the skin.
    4. Apply enough medication on the affected areas according to your doctor’s instructions
    - For Tacrolimus: Apply the medication 2 hours after applying the moisturiser
    - For Pimecrolimus: Apply the medication after applying the moisturiser
    5. Wash your hands after applying the medicationAvoid applying the medication too near your eyes, mouth and nose (unless specifically instructed) as it may cause irritation
  • Flush the area thoroughly with water if the medication accidentally gets into your eyes, mouth, and nose
  • Do not cover the treated skin with bandages, dressings or wraps. You can wear normal clothing.
  • If you feel that the medication is not working well, do not apply more than instructed. Check with your doctor. 

What should I do if I forget a dose?

If you forgot to apply a dose of this medication, apply it as soon as you remember. Skip the dose if it is almost time for the next dose. Apply your next dose at the usual time. Do not apply two doses to make up for the missed dose. 


What precautions should I take?

Inform your healthcare professional if: 
  • You are allergic to this medication or any of the other ingredients of this medication
  • You are pregnant, planning to become pregnant, or breastfeeding 
  • You suspect that you have an infection on your skin e.g. chickenpox or herpes
  • You have a weakened immune system (immunocompromised)
  • You are on ultraviolet light therapy, using sun lamps or tanning bed     
    • Avoid staying directly under sunlight or ultraviolet light for long durations. Use a broad-spectrum sunscreen product with Sun Protection Factor (SPF) of at least 30 and wear protective clothing when you are exposed to direct sunlight.
  • You have a history of skin cancer     
    • The association of skin cancer and this medication has not been proven. Safety of long-term use of this medication is unknown. Avoid using this medication continuously for a long time. If needed, treatment may be repeated with breaks in between.

What are some side-effects that I need to seek medical advice immediately?

The symptoms of a drug allergy include one or more of the following:
  • Swollen face/eyes/lips/tongue
  • Difficulty in breathing
  • Itchy skin rashes over your whole body
If you experience any of these symptoms, you should stop your medication and see your
healthcare professional immediately.

What are some other side-effects of this medication?

Certain side effects of this medication are common and may even disappear during treatment. If any of the following side effects do not go away or are severe, consult your doctor.

The most common side effects at the site of application are warm sensation (sometimes burning), stinging or itching of the skin. This is usually mild to moderate and most common during the first few days of treatment. It usually lessens as your skin heals.

Other side effects include:
  • Headache
  • Flu-like symptoms such as blocked or runny nose 
  • Skin infections such as cold sores, chicken pox or shingles

How should I store this medication?

Store in a cool and dry place, away from direct sunlight. Keep this medication away from children. 


How should I throw away this medication safely?

Pack this medication into a black trash bag and seal it tightly before throwing into the rubbish chute or bin. 

Disclaimers
If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore.

Last reviewed on December 19
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Topical Calcineurin Inhibitors

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