Tacrolimus

Everyone who's tried it says it's been a miracle for quickly achieving remission. You do need monitoring though, and it's not usually seen as a long-term option, though I've seen some conflicting information overall. I didn't try it myself. It's mostly used as rescue and a bridge to another treatment. Is that what you're thinking? People also use it topically as suppositories - only somewhat recently i've seen this mentioned. Sounds like long-term oral use usually results in intolerable side effects over time, but this information is from a quick search on google, I am certainly not the authority.

My dog is on it daily for dermatitis and he does fantastic - it's been years. Interesting how a dog can use it daily without consequence.

As other's have said IV tacrolimus is a short-term rescue medication much like IV-steroids, IV Cyclosporine, or double-dose IV Remicade are. Tacrolimus is a strong, fast-acting immunomodulator, much like Cyclosporine that works well for many while you're on it. Much like prednisone, Tacrolimus/Cyclosporine is only for temporary usage and therefore you need an escape plan for what you will use afterwards to sustain your quality of life (they buy you time while other maintenance treatment meds are given time to work). Tacrolimus/Cyclosporine is often used when someone is steroid-refractory (meaning IV steroids do not work). You'd take Tacrolimus/Cyclosporine with the hopes of that working or else you're slated for an emergency surgery for a colectomy. It's one of those nuclear weapons we have in our arsenal but only used sparingly when everything is FUBAR (F'ed/Fouled Up Beyond All Recognition/Any Repair/All Reason) and there is no other choice but to try it to tame a flare.

Some teaching-hospitals might try to use Tacrolimus/Cyclosporine in more novel ways, and perhaps not as a last-ditch effort as would be done in more traditional GI-practices. For example, I've heard of Tacrolimus Suppositories being used experimentally in some UC patients, sometimes with results.

Embellish us a little bit about your situation, whats' the current state of your UC?, what meds are you currently on?, and How bad are your UC symptoms?

Just saw this and wanted to respond. I’ve been on tacrolimus suppositories on and off since late April. They have been FANTASTIC when Remicade was not getting the job done. I only had a partial response to prednisone, but it didn’t get me close to remission, so this has been my rescue drug.

The suppositories need to be made at a compounding pharmacy since they are used off-label for UC; your IBD center/doctor can arrange this. They need to be refrigerated at all times.

I have had minor side effects (skin feels kind of hot most of the time - this is the only side effect that doesn’t go away right away; there was a little stomach upset for the first few days; and a bit of burning from the supps themselves for the first few days). Tacrolimus suppository side effects are NOTHING compared to what prednisone did to me ;)

Your tacrolimus levels do need to be monitored as NSSG mentioned. Mine ran high on two doses per day so I’m now at 1 dose per day while waiting to start Entyvio. I don’t know that the suppositories will do much for inflammation beyond the rectum, but for those with proctitis (which is where my disease is now), it’s a great option.

Tacrolimus saved me.

I was losing blood and in an AWFUL flare *for a LONG TIME* that Prednisone WOULD NOT BUDGE. Once I was transferred to a hospital that knew what they were doing, they chose oral Tacrolimus and ditched the Prednisone. It worked wonders for me in a very short time period, and I experienced ZERO side effects!

The only downside of it is that you need your blood checked pretty regularly to ensure the tacrolimus levels are therapeutic and not toxic.

Mind you* I did not reach remission with Tacrolimus, and I don't believe that it's used to attempt to get people into remission, just as Prednisone is not. You're typically going to need further treatment, depending on the severity of your situation. Tacrolimus was used in my situation in order to bridge me onto my biologics and get me leaning on those, and get me off of Tacrolimus.