Insulin-dependent post-transplant diabetes mellitus reported (increased risk in African-American and Hispanic kidney transplant patients). Increased susceptibility to infection and possible development of lymphoma may result from immunosuppression with tacrolimus. Nephrotoxicity and neurotoxicity reported, especially with higher doses. Tonic-clonic seizures may have been triggered by tacrolimus. A period of 24 hours should elapse between discontinuation of cyclosporine and initiation of tacrolimus. Use caution in renal or hepatic dysfunction. Delay initiation if postoperative oliguria occurs. Use may be associated with development of hypertension (common). Myocardial hypertrophy reported (rare). Anaphylaxis reported with injection (use should be reserved for patients unable to take oral medications). Topical calcineurin inhibitors associated with rare cases of malignancy (including skin and lymphoma). Use in children <2 years of age not recommended; children aged 2-15 should only use 0.03% ointment. Avoid use on malignant or premalignant skin conditions. Should not be used in immunocompromised patients. Do not apply to areas of active bacterial or viral infection. Tacrolimus therapy associated with risk of developing eczema herpeticum, varicella zoster, and herpes simplex. May be associated with development of lymphadenopathy. Discontinue use in unknown cause of lymphadenopathy or acute infectious mononucleosis. Acute renal failure observed (rarely) with topical use. Not recommended for use in skin disease which may increase systemic absorption. Sunlight exposure should be minimal during treatment.