Adverse effects of Tacrolimus include all of the following EXCEPT (AIPG 2009)
a. Tacrolimus (FK506)—It is a newer immunosuppressant chemically different from cyclosporine, but having the same mechanism of action, and is 100 times more potent.
b. It binds to a different cytoplasmic immunophilin protein labeled ‘FKBP’, but the subsequent steps are the same, i.e. inhibition of helper T cells via calcineurin.
c. Tacrolimus is administered orally as well as by IV infusion. Oral absorption is variable and decreased by food.
d. It is metabolized by CYP3A4 and excreted in bile with a longer TVZ of 12 hour.
e. Therapeutic application, clinical efficacy as well as toxicity profile are similar to cyclosporine. It is particularly valuable in liver transplantation because its absorption is not dependent on bile.
f. Because of more potent action, it is also suitable for suppressing acute rejection that has set in.
g. Hypertension, hirsutism and gum hyperplasia are less marked than cyclosporine; tacrolimus is more likely to precipitate diabetes, cause neurotoxicity, alopecia and diarrhea.