Tacrolimus for KCS

RE: Tacrolimus for KCS

Bob Russell — Thu, 22 Oct 2015 13:59:38 GMT

Seem to remember a tube is about £30 online or £45 from Boots! Not really a big cost to the client so little justification for squeezing the last drop out a year or more on!

I now have a concrete reason to tell them to bin the tube regularly!!

RE: Tacrolimus for KCS

Martin Atkinson — Wed, 21 Oct 2015 17:18:49 GMT

[quote user="Robert Lowe"]I would never see my clients again if I suggested this).[/quote]

RE: Tacrolimus for KCS

Robert Lowe — Wed, 21 Oct 2015 16:57:59 GMT

[quote user="Mike Nikolaou"]

Does anyone know how often one has to use the available tacrolimus 0.03% skin oint for KCS? I'm looking all around but can't find any dosage schedules...

[/quote]

twice daily

Rob

RE: Tacrolimus for KCS

Robert Lowe — Wed, 21 Oct 2015 16:56:38 GMT

[quote user="Iain McAllister"]

Anyone know best percentage to start on for max chance of a response...? thanks

[/quote]

Hi Iain

Cyclosporin drops - we usually start at 2% in non-responsive cases (you can go to 3% but we see more irritation)

However, we rarely use cyclosporin as tacrolimus seems much more effective in the group where Optimmune is not or no longer effective. In severe cases we go straight to the 0.1% strength but usually try 0.03% first.

Where clients have used the tube longer than 6 months we see an increase in irritation so always try and get them using a new tube at least every 6 months (I know it should be 28 days but I would never see my clients again if I suggested this).

Rob

RE: Tacrolimus for KCS

Iain McAllister — Wed, 21 Oct 2015 15:16:32 GMT

Anyone know best percentage to start on for max chance of a response...? thanks

RE: Tacrolimus for KCS

Martin Atkinson — Wed, 21 Oct 2015 12:08:57 GMT

[quote user="Bob Russell"]Following advice given at one of Rob Lowes CPD days, I have used Tacrolimus in poorly responsive cases. Works well and clients love it as the tube last forever and ever and ever........[/quote]I'm a Rob Lowe disciple as well and ditto experience with the longevity of the tube.

[quote user="Iain McAllister"]How long would a tube of tacrolimus last do you think.[/quote]When I started I couldn't get it from NVS so I gave the owner a script. She came back for a new one about twice a year!

RE: Tacrolimus for KCS

Iain McAllister — Wed, 21 Oct 2015 11:43:57 GMT

How long would a tube of tacrolimus last do you think... we are selling it out at about £130 for a 30g tube - a made up bottle of 0.5% cyclosporine is £30 - I have already told the owner I'm going to make up the cyclosporine drop so a bit cautious about changing my mind selling him the tacrolimus and it not working!! Plus our tacrolimus has an expiry date of Dec 15 on it...

RE: Tacrolimus for KCS

Bob Russell — Wed, 21 Oct 2015 11:25:26 GMT

Following advice given at one of Rob Lowes CPD days, I have used Tacrolimus in poorly responsive cases. Works well and clients love it as the tube last forever and ever and ever........

Despite suggestions that tubes do not remain sterile indefinitely!

RE: Tacrolimus for KCS

Iain McAllister — Wed, 21 Oct 2015 10:55:18 GMT

Sandimmun is injectable cyclosporine - this is the info I have been working with - found on an Aussie ophthalmologists website

High Concentration Cyclosporin preparations for Refractory Dry Eye

Sandimmun injection is a 50mg/ml concentration of cyclosporine - it has been used by many veterinary ophthalmologists to successfully treat refractory dry eye

Sandimmune injection is 50mg/ml

Therefore to make a compounded solution - use the following recipes - please note use corn oil only

0.5% - 1ml Sandimmune in 9ml corn oil

1% - 2ml Sandimmune in 8ml corn oil OR 1ml Sandimmune in 4ml Corn oil

2% - 4ml Sandimmune in 6ml corn oil OR 2ml Sandimmune in 3ml corn oil OR 1ml Sanimmun in 1.5ml corn oil

Ocular irritation reactions, including conjunctival hyperemia, periocular alopecia and blepharitis can occur when increased concentrations of cyclosporine are used. Usually it is best to start off giving 0.5% and working up to 1% or 2% if needed, The owner should sign off licence consent

RE: Tacrolimus for KCS

Martin Atkinson — Wed, 21 Oct 2015 10:20:24 GMT

I had a KCS case that was refractory to cyclosporin so we changed to Tacromilus and it did very well, owner applied a dot on the end of a cotton bud bid. Not heard of Sandimmun. In the end even that didn't work though and the owner requested I enucleate the eye.

RE: Tacrolimus for KCS

Iain McAllister — Wed, 21 Oct 2015 09:44:03 GMT

I have a refractory KCS case - I have 0.03% Tacrolimus and Sandimmun on the shelf - which would you choose?

If choosing cyclosporine which percentage would you start at - 0.5% or 1% - is there a strong chance of blepharitis and other side effects if going straight in at 1%

thanks

Re: Tacrolimus for KCS

Robert Lowe — Mon, 05 Jul 2010 09:52:36 GMT

I also recommend the haemorrhoid cream applicator tip but we also advise the use of a tightly bound cotton bud to apply a small amount onto the lower eyelid without the need for the tip.

We use a LOT of 0.03% tacrolimus and have not had any reports of it stinging. I also believe that the reports of carciongenic problems in humans are not true but I haven't seen the publications for this. It is also why we recommend a cotton bud approach so that the owner reduces the risk of skin contact anyway.

Re: Tacrolimus for KCS

Lynne Faulconbridge — Sun, 04 Jul 2010 23:05:58 GMT

Helpful tip- an ophthalmologist I spoke to said that the "internal use" nozzle supplied with tubes of Anusol haemorrhoid cream fits perfectly onto the top of a tacrolimus ointment tube -this helps in application of the tacrolimus to the eye (it is very gloopy). She said she did not know how the client who discovered this had discovered it........but it helps!!

Re: Tacrolimus for KCS

Mike Nikolaou — Sat, 03 Jul 2010 12:07:22 GMT

I have had this dog on tacrolimus 0.03% for 4 weeks now, by week 3 his schirmer's had increased to 10mm - great news as even on cyclosporin 25 he was making no progress...

Thanks again for all the replies guys!

Re: Tacrolimus for KCS

Rob Loxley — Sat, 05 Jun 2010 17:49:53 GMT

Last talk I went to on KCS, by one of the AHT's Ophthalmology Dept, suggested using 2% cyclosporine in oil as a next step after the 0.2% Optimmune, unless you have neurogenic KCS which don't respone to cyclosporine.

Re: Tacrolimus for KCS

chris Jones — Sat, 05 Jun 2010 17:18:07 GMT

have you tried the 'home prep' version of cyclosp in corn oil to increase the percentage as optimmubne sometimes isnt effective at its lower percentage. If not its certainly worth a shot first as tacrolimus isnt used much other than by some at the AHT or other specialists, it stings and there is some worry over its carcinogenicity for the dog and the owner. saying that I know of people using it with good results.

if you are going to use it I would advise speaking to one of the clinicians at the AHT

Re: Tacrolimus for KCS

Mike Nikolaou — Fri, 04 Jun 2010 22:39:21 GMT

Thanks for both replies!

Re: Tacrolimus for KCS

Stephen Courtney — Fri, 04 Jun 2010 21:32:56 GMT

I was at a BSAVA CPD that Christine Heinrich was doing on ophtho, she said you get best results with the stronger of the two versions of the ointment, i think it is the 0.1% ointment? Don't have a Mims to hand.

I would use it twice a day, bear in mind you can only use this stuff if Optimune is not strong enough.

Re: Tacrolimus for KCS

HMC — Fri, 04 Jun 2010 18:22:04 GMT

BSAVA formulary:

"Doses: dogs: apply small amount of ointment to the affected eye q12h"