Contraindications and precautions
Contraindications and precautions include:
Hepatic disease
Immunosuppression
Infants
Infection
Neoplastic disease, such as:
Skin cancer
Lung cancer
Oliguria
Pregnancy
QT interval prolongation
Sunlight (UV) exposure
Grapefruit juice

Topical use
Occlusive dressing
Known or suspected malignant lesions
Nethertons syndrome or similar skin diseases
Certain skin infections

Side effects
By mouth or intravenous use
Side effects can be severe and include infection, cardiac damage, hypertension, blurred vision, liver and kidney problems (tacrolimus nephrotoxicity), hyperkalemia, hypomagnesemia, hyperglycemia, diabetes mellitus, itching, lung damage (sirolimus also causes lung damage), and various neuropsychiatric problems such as loss of appetite, insomnia, posterior reversible encephalopathy syndrome, confusion, weakness, depression, vivid nightmares, cramps, neuropathy, seizures, tremors, and catatonia.In addition, it may potentially increase the severity of existing fungal or infectious conditions such as herpes zoster or polyoma viral infections. Carcinogenesis and mutagenesis
In people receiving immunosuppressants to reduce transplant graft rejection, an increased risk of malignancy (cancer) is a recognised complication. The most common cancers are non-Hodgkins lymphoma and skin cancers. The risk appears to be related to the intensity and duration of treatment. Topical use
The most common adverse events associated with the use of topical tacrolimus ointments, especially if used over a wide area, include a burning or itching sensation on the initial applications, with increased sensitivity to sunlight and heat on the affected areas. Less common are flu-like symptoms, headache, cough, and burning eyes. Cancer risks
Tacrolimus and a related drug for eczema (pimecrolimus) were suspected of carrying a cancer risk, though the matter is still a subject of controversy. The FDA issued a health warning in March 2005 for the drug, based on animal models and a small number of patients.
), ruptured aortic aneurysm, superior mesenteric artery syndrome, etc. Severe dehydration
Third spacing, e.g. malignant pleural effusion, ascites, severe peripheral oedema due to kidney failure
Rapid fluid shift due to dialysis
Cardiogenic shock
Myocardial infarction
Severe cardiac arrhythmia, e.g. ventricular fibrillation, sea water poisoning
Failed heart transplant or artificial heart; in those with cardiovascular disease who are just being treated with medical therapy or oxygen, pacing, cardioversion, or defibrillation using an implantable cardioverter-defibrillator, or else implantation of an intra-aortic balloon pump, or a unilateral or bilateral ventricular assist device, may help matters, as could the use of stenting and/or coronary artery bypass surgery and/or the removal of atherosclerotic plaques. Eventually, a heart transplant or artificial heart may be needed, and these can be replaced when they are no longer performing as well as they did. If necessary, while waiting for a transplant or device, extracorporeal membrane oxygenation (ECMO) or mechanical ventilation using a ventilator, or other less invasive methods, can be used to help compensate. If other systems get impaired, renal dialysis, liver dialysis, and artificial nutrition and hydration (including total or partial parenteral nutrition) can also be used. Congenital heart defects
Obstructive shock
Pulmonary embolism
Cardiac tamponade
Aortic dissection
Tension pneumothorax
Hypertrophic cardiomyopathy
Constrictive pericarditis
Distributive shock
Septic shock
Anaphylactic shock
Acute pancreatitis
Hypotension due to medications
Intoxicative inhalants
Combined
Dengue fever

Effects
The effects of a circulatory collapse vary based on the type of collapse it is.