Tacrolimus Anhydrous

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Also known as Anhydrous tacrolimusFujimycinPrographTacroTacrolimusanhydrousTsukubaenolideENVARSUSVIVADEXPERIXISCAPEXIONTACROLIMUS HYDRATEADOPORTTACNIMODIGRAFADVAGRAFFK5MOLECULAR-GLUEFK-506

Summary

Tacrolimus Anhydrous (CHEMBL269732) is an approved small-molecule immunosuppressive agent targeting FKBP1A and TRPM8; indicated across 131 conditions including hepatocellular carcinoma and hodgkins lymphoma.

At a glance

  • Status: Approved (max clinical phase 4)
  • Modality: Small molecule
  • Targets: 2 (FKBP1A, TRPM8)
  • Indications: 131 conditions
  • Clinical trials: 891
  • Chemistry: 804 Da · C44H69NO12

Identifiers

Drug identity and classification

FieldValue
ChEMBL IDCHEMBL269732
NameTacrolimus Anhydrous
TypeSmall molecule
Max phase4
FDA approvedyes
PubChem CID445643
ChEBICHEBI:61049
Molecular formulaC44H69NO12
Molecular weight804
InChIKeyQJJXYPPXXYFBGM-LFZNUXCKSA-N

SMILES: C[C@@H]1C[C@@H]([C@@H]2[C@H](C[C@H]([C@@](O2)(C(=O)C(=O)N3CCCC[C@H]3C(=O)O[C@@H]([C@@H]([C@H](CC(=O)[C@@H](/C=C(/C1)\C)CC=C)O)C)/C(=C/[C@@H]4CC[C@H]([C@@H](C4)OC)O)/C)O)C)OC)OC

IUPAC name: (1R,9S,12S,13R,14S,17R,18E,21S,23S,24R,25S,27R)-1,14-dihydroxy-12-[(E)-1-[(1R,3R,4R)-4-hydroxy-3-methoxycyclohexyl]prop-1-en-2-yl]-23,25-dimethoxy-13,19,21,27-tetramethyl-17-prop-2-enyl-11,28-dioxa-4-azatricyclo[22.3.1.04,9]octacos-18-ene-2,3,10,16-tetrone

ChEBI definition: A macrolide lactam containing a 23-membered lactone ring, originally isolated from the fermentation broth of a Japanese soil sample that contained the bacteria Streptomyces tsukubaensis.

Pharmacological roles (ChEBI): immunosuppressive agent.

Other ChEBI roles (chemical / environmental): bacterial metabolite.

Also known as: Anhydrous tacrolimus, Fujimycin, Prograph, Tacro, Tacrolimus anhydrous, Tacrolimus, anhydrous, Tsukubaenolide, ENVARSUS, VIVADEX, PERIXIS, CAPEXION

Parent form; salt/anhydrous children: CHEMBL3989887

Patent coverage: 23,926 distinct patent families (95,168 SureChEMBL compound mentions), from 1 matched compound structure(s). Mentions count patents naming the compound (not distinct inventions), so promiscuous / reference molecules inflate the mention figure — families are the dedup metric.

Targets

Targets

Primary targets (GtoPdb curated mechanism): the Cancer dependency column is the DepMap CRISPR fitness signal (% of screened cell lines dependent on the target).

GeneTargetActionpAffinityCancer dependencyUniProt
FKBP1AFKBP prolyl isomerase 1AInhibition9.421.5%P62942
TRPM8TRPM8Agonist4.850.5%Q7Z2W7

Broader ChEMBL bioactivity targets: 27 (assay-derived). Sample: Splicing factor 3B subunit 3, Nuclear receptor ROR-gamma, Ferritin light chain, Solute carrier organic anion transporter family member 1B1, 5-hydroxytryptamine receptor 2B, Alpha-2A adrenergic receptor, Peptidyl-prolyl cis-trans isomerase FKBP1A, Sodium channel protein type 5 subunit alpha, Equilibrative nucleoside transporter 1, Peptidyl-prolyl cis-trans isomerase FKBP5.

Bioactivity

ChEMBL activities: 45 potent at pChembl ≥ 5 of 60 total. Top 30 by potency (10 = 0.1 nM, 6 = 1 µM):

TargetpChemblTypeValueUnitActivity ID
FKBP1A9.7Kd0.2nMCHEMBL_ACT_1194515
FKBP1A9.7Kd0.2nMCHEMBL_ACT_188123
FKBP1A9.7Kd0.2nMCHEMBL_ACT_26165917
FKBP1A9.4Ki0.4nMCHEMBL_ACT_1007850
FKBP1B9.4Kd0.4nMCHEMBL_ACT_15049580
FKBP1A9.4Kd0.4nMCHEMBL_ACT_25072940
FKBP1A9.05EC500.9nMCHEMBL_ACT_378184
MTOR9.02IC500.95nMCHEMBL_ACT_1468060
FKBP1B8.83Kd1.49nMCHEMBL_ACT_26165920
FKBP1A8.77Ki1.7nMCHEMBL_ACT_25848558
FKBP1A8.64IC502.3nMCHEMBL_ACT_1086804
FKBP1A8.6IC502.5nMCHEMBL_ACT_724502
MTOR8.5IC503.16nMCHEMBL_ACT_873240
SF3B37.96IC5010.9nMCHEMBL_ACT_3441240
SF3B37.86IC5013.8nMCHEMBL_ACT_3441228
FKBP1A7.85IC5014.05nMCHEMBL_ACT_18083828
PPP3CA7.83IC5014.8nMCHEMBL_ACT_378185
PPP3CA7.7Kd20nMCHEMBL_ACT_188124
FKBP47.64Kd23nMCHEMBL_ACT_25072935
FKBP57.12Kd75.93nMCHEMBL_ACT_26165923
FKBP57.1Ki80nMCHEMBL_ACT_12726905
FKBP57.1Ki79nMCHEMBL_ACT_16556235
FKBP57.03Ki93nMCHEMBL_ACT_25072933
FKBP56.98Kd104nMCHEMBL_ACT_25072929
CYP3A46.92IC50120nMCHEMBL_ACT_15464653
CYP3A56.85IC50140nMCHEMBL_ACT_15464659
FKBP46.83Kd149.7nMCHEMBL_ACT_26165926
CYP3A46.44Ki360nMCHEMBL_ACT_15464649
CYP3A46.21IC50620nMCHEMBL_ACT_15464654
CYP3A46.21Ki610nMCHEMBL_ACT_15464661

Target pathways

Aggregated over 2 target gene(s): FKBP1A, TRPM8.

Top Reactome pathways

8 total, by targets touching each:

PathwayTargetsGenes
mTORC1-mediated signalling1FKBP1A
Calcineurin activates NFAT1FKBP1A
TGF-beta receptor signaling activates SMADs1FKBP1A
TGF-beta receptor signaling in EMT (epithelial to mesenchymal transition)1FKBP1A
TRP channels1TRPM8
TGFBR1 LBD Mutants in Cancer1FKBP1A
Potential therapeutics for SARS1FKBP1A
SARS-CoV-1 activates/modulates innate immune responses1FKBP1A

Dominant GO biological processes

GO termTargets
heart morphogenesis1
protein folding1
‘de novo’ protein folding1
regulation of cardiac muscle contraction by regulation of the release of sequestered calcium ion1
regulation of skeletal muscle contraction by regulation of release of sequestered calcium ion1
negative regulation of transforming growth factor beta receptor signaling pathway1
regulation of protein localization1
negative regulation of activin receptor signaling pathway1
protein refolding1
T cell activation1
positive regulation of canonical NF-kappaB signal transduction1
regulation of immune response1
protein maturation1
ventricular cardiac muscle tissue morphogenesis1
heart trabecula formation1

Indications & clinical

Indications

131 indications (0 at ChEMBL trial phase 4). Phase below is the highest clinical-trial phase recorded for this drug against each disease — not the molecule’s overall approval status (that is in the Summary).

IndicationTrial phaseMONDOEFO
hepatocellular carcinoma3MONDO:0007256EFO:0000182
Hodgkins lymphoma3MONDO:0004952EFO:0000183
atopic eczema3MONDO:0004980EFO:0000274
infertility disorder3MONDO:0005047EFO:0000545
injury3MONDO:0021178EFO:0000546
psoriasis3MONDO:0005083EFO:0000676
rheumatoid arthritis3MONDO:0008383EFO:0000685
ulcerative colitis3MONDO:0005101EFO:0000729
kidney disorder3MONDO:0005240EFO:0003086
heart disorder3MONDO:0005267EFO:0003777
chronic kidney disease3MONDO:0005300EFO:0003884
vitiligo3MONDO:0008661EFO:0004208
nephrotic syndrome3MONDO:0005377EFO:0004255
graft versus host disease3MONDO:0013730EFO:0004599
myasthenia gravis3MONDO:0009688EFO:0004991
lupus nephritis3MONDO:0005556EFO:0005761
non-Hodgkin lymphoma3MONDO:0018908EFO:0005952
bronchiolitis obliterans syndrome3MONDO:0015265EFO:0007183
seborrheic dermatitis3MONDO:0006608EFO:1000764
membranous glomerulonephritis3MONDO:0005376EFO:0004254
kidney failure3MONDO:0001106EFO:1002048
skin neoplasm3MONDO:0002531MONDO:0002898
severe acute respiratory syndrome3MONDO:0005091MONDO:0100096
acute pancreatitis3MONDO:0006515EFO:1000652
type 1 diabetes mellitus3MONDO:0005147MONDO:0005147
B-cell chronic lymphocytic leukemia2MONDO:0004948EFO:0000095
myelodysplastic syndrome2MONDO:0018881EFO:0000198
acute lymphoblastic leukemia2MONDO:0004967EFO:0000220
acute myeloid leukemia2MONDO:0018874EFO:0000222
chronic myeloid leukemia2MONDO:0011996EFO:0000339
Crohn disease2MONDO:0005011EFO:0000384
diabetes mellitus2MONDO:0005015EFO:0000400
diffuse large B-cell lymphoma2MONDO:0018905EFO:0000403
leukemia2MONDO:0005059EFO:0000565
lymphoma2MONDO:0005062EFO:0000574
neoplasm2MONDO:0005070EFO:0000616
neuroblastoma2MONDO:0005072EFO:0000621
sarcoma2MONDO:0005089EFO:0000691
systemic sclerosis2MONDO:0005100EFO:0000717
pulmonary arterial hypertension2MONDO:0015924EFO:0001361
age-related macular degeneration2MONDO:0005150EFO:0001365
plasma cell myeloma2MONDO:0009693EFO:0001378
liver disorder2MONDO:0005154EFO:0001421
encephalomyelitis2MONDO:0005156EFO:0001423
lymphoid neoplasm2MONDO:0005157EFO:0001642
primary myelofibrosis2MONDO:0009692EFO:0002430
hepatitis C virus infection2MONDO:0005231EFO:0003047
lung disorder2MONDO:0005275EFO:0003818
cutaneous lupus erythematosus2MONDO:0005282EFO:0003834
colitis2MONDO:0005292EFO:0003872
IgA glomerulonephritis2MONDO:0005342EFO:0004194
chronic hepatitis C virus infection2MONDO:0005354EFO:0004220
focal segmental glomerulosclerosis2MONDO:0100313EFO:0004236
autoimmune hepatitis2MONDO:0016264EFO:0005676
aplastic anemia2MONDO:0015909EFO:0006927
atopic conjunctivitis2MONDO:0005642EFO:0007141
juvenile myelomonocytic leukemia2MONDO:0011908EFO:1000309
vulvar lichen sclerosus2MONDO:0006491EFO:1000623
epidermolysis bullosa2MONDO:0006541EFO:1000690
Sezary syndrome2MONDO:0017844EFO:1000785
mycosis fungoides2MONDO:0009691EFO:1001051
mantle cell lymphoma2MONDO:0018876EFO:1001469
peripheral T-cell lymphoma, not otherwise specified2MONDO:0004964EFO:0000211
angioimmunoblastic T-cell lymphoma2MONDO:0004977EFO:0000255
Burkitt lymphoma2MONDO:0007243EFO:0000309
acquired polycythemia vera2MONDO:0009891EFO:0002429
anaplastic large cell lymphoma2MONDO:0020325EFO:0003032
lichen planus, oral2MONDO:0043923EFO:0008517
Waldenstrom macroglobulinemia2MONDO:0100280EFO:0009441
Langerhans cell histiocytosis2MONDO:0018310EFO:1000318
chronic myelomonocytic leukemia2MONDO:0020311EFO:1001779
myeloproliferative neoplasm2MONDO:0020076EFO:0002428
kidney cancer2MONDO:0002367MONDO:0002367
follicular lymphoma2MONDO:0018906MONDO:0018906
nasal cavity and paranasal sinus lethal midline granuloma2MONDO:0006828MONDO:0019472
hematopoietic and lymphoid system neoplasm2MONDO:0002334MONDO:0044881
autoimmune thrombocytopenic purpura2MONDO:0008558EFO:0007160
minimal change disease2MONDO:0006835EFO:1001020
myelodysplastic/myeloproliferative disease2MONDO:0020077MONDO:0020077
MALT lymphoma2MONDO:0007650EFO:0000191
ischemia reperfusion injury2MONDO:0005203EFO:0002687
amyotrophic lateral sclerosis2MONDO:0004976MONDO:0004976
asthma2MONDO:0004979MONDO:0004979
multiple sclerosis2MONDO:0005301MONDO:0005301
Wiskott-Aldrich syndrome2MONDO:0010518MONDO:0010518
sickle cell disease2MONDO:0011382MONDO:0011382
Diamond-Blackfan anemia2MONDO:0015253MONDO:0015253
severe combined immunodeficiency2MONDO:0015974MONDO:0015974
lymphedema2MONDO:0019297MONDO:0019297
Sjogren syndrome2MONDO:0010030EFO:0000699
skin disorder2MONDO:0005093EFO:0000701
hemoglobinuria2MONDO:0003656MONDO:0100244
plasma cell neoplasm2MONDO:0004959EFO:0000200
liver failure2MONDO:0100192MONDO:0100192
reproductive system disorder1MONDO:0005039EFO:0000512
venous thromboembolism1MONDO:0005399EFO:0004286
plasma cell leukemia1MONDO:0018689EFO:0006475
aspergillosis1MONDO:0005657EFO:0007157
acute kidney tubular necrosis1MONDO:0006637EFO:1000794
scleroderma1MONDO:0019340EFO:1001993
beta thalassemia1MONDO:0019402Orphanet:848
vasculitis1MONDO:0018882EFO:0006803
blast phase chronic myelogenous leukemia, BCR-ABL1 positive1MONDO:0006115EFO:1000131
respiratory syncytial virus infectious disease1MONDO:0001577EFO:1001413
hematologic disorder1MONDO:0005570EFO:0005803
alopecia1MONDO:0004907MONDO:0004907
DiGeorge syndrome1MONDO:0008564MONDO:0018923
alopecia areata1MONDO:0005340EFO:0004192
lymphoid leukemia1MONDO:0005402EFO:0004289
myeloid leukemia1MONDO:0004643MONDO:0004643
neuroepithelial neoplasm0MONDO:0021193MONDO:0021193

20 further indication records had no mapped disease name (EFO/MeSH-only) or were duplicates, and are omitted.

Clinical trials

Total trials: 891.

Phase distribution

PhaseTrials
PHASE2292
PHASE4213
PHASE3118
Not specified94
PHASE184
PHASE1/PHASE255
PHASE2/PHASE324
EARLY_PHASE111

Top trials by phase / activity

NCTPhaseStatusTitle
NCT02081755PHASE4ENROLLING_BY_INVITATIONSafety and Efficacy of Everolimus Treatment in Liver Transplantation for Liver Cancer
NCT03266393PHASE4ACTIVE_NOT_RECRUITINGEnvarsus XR® in Adolescent Renal Transplant Recipients
NCT04720326PHASE4ACTIVE_NOT_RECRUITINGBioavailability and Practicability of Envarsus Versus Advagraf in Liver Transplant Recipients
NCT05089604PHASE4RECRUITINGTacrolimus Associated Tremors in Liver Transplantation: Immediate-Release Versus Extended-Release Formulations
NCT05242315PHASE4RECRUITINGExtended-Release Tacrolimus Following Liver Transplantation
NCT05655273PHASE4ENROLLING_BY_INVITATIONConversion of Maintenance Prograf to Envarsus in Liver Transplant Recipients
NCT05916781PHASE4RECRUITINGEffectiveness of Mycophenolate Mofetil Combined With Tacrolimus for Steroid Tapering in Systemic Lupus Erythematosus
NCT06147648PHASE4NOT_YET_RECRUITINGEarly Conversion of Prolonged-release Tacrolimus in Liver Transplantation.
NCT06203470PHASE4NOT_YET_RECRUITINGBotox Versus Tacrolimus in Psoriasis Vulgaris
NCT06268769PHASE4RECRUITINGTacrolimus C:D Ratio Measured in Renal Transplant Recipients Treated With Once-daily Prolonged-release Drugs
NCT06529536PHASE4RECRUITINGUtilising Genotype Informed Bayesian Dosing of Tacrolimus in Children Post Solid Organ Transplantation.
NCT06701825PHASE4RECRUITINGEffectiveness and Cost-effectiveness of a Pre-emptive Genotyping Strategy in Patients Receiving Tacrolimus
NCT07352566PHASE4NOT_YET_RECRUITINGUtilization of a Microdevice for Psoriasis and Atopic Dermatitis
NCT07437534PHASE4NOT_YET_RECRUITINGComparative Evaluation of the Safety and Effectiveness of Crisaborole Ointment (2%) Versus Tacrolimus Ointment (0.1%) for the Topical Treatment of Atopic Dermatitis
NCT00087581PHASE4COMPLETEDStudy of Therapeutic Monitoring of Mycophenolate Mofetil (MMF/CellCept) After Kidney Transplantation
NCT00106392PHASE4COMPLETEDA Safety and Efficacy Study of Prograf in the Prevention of Erectile Dysfunction After Radical Prostatectomy
NCT00113269PHASE4COMPLETEDSafety/Efficacy of Induction Agents With Tacrolimus, MMF, and Rapid Steroid Withdrawal in Renal Transplant Recipients
NCT00118742PHASE4COMPLETEDLiver Spare the Nephron (STN) Study - A Study of CellCept (Mycophenolate Mofetil) and Sirolimus in Recipients of a Liver Transplant
NCT00125307PHASE4COMPLETEDTacrolimus for the Treatment of Systemic Lupus Erythematosus With Membranous Nephritis
NCT00133172PHASE4TERMINATEDEffect of Rapid Steroid Withdrawal on Subclinical Markers of Rejection
NCT00149994PHASE4COMPLETEDCyclosporine A C-2h Monitoring Versus Tacrolimus C-0h Monitoring in de Novo Liver Transplant Recipients
NCT00160966PHASE4COMPLETEDImpact of Immunosuppressive Regimens on Polyomavirus-related Transplant Nephropathy
NCT00163657PHASE4COMPLETEDStudy of Liver Transplant For End-Stage Liver Disease Caused By Chronic Hepatitis C Infection
NCT00166712PHASE4TERMINATEDA Trial of Two Steroid-Free Approaches Toward Mycophenolate Mofetil-Based Monotherapy Immunosuppression
NCT00166816PHASE4UNKNOWNThe Pharmacokinetics of Sirolimus When Combined With Cyclosporine or Tacrolimus in Renal Transplant Patients
NCT00166829PHASE4UNKNOWNThe Effect of Sirolimus on the Pharmacokinetics of Tacrolimus
NCT00166842PHASE4UNKNOWNSirolimus Blood Concentrations on Conversion From Oral Solution to Tablets
NCT00171496PHASE4COMPLETEDEvaluation of Cyclosporine Microemulsion and Tacrolimus on the Rate of New Onset Diabetes Mellitus in Kidney Transplantation Recipients
NCT00177138PHASE4TERMINATEDUse of Campath for Induction and Maintenance Therapy in Pancreas After Kidney Transplantation
NCT00182559PHASE4COMPLETEDThe Vienna Prograf and Endothelial Progenitor Cell Study
NCT00195429PHASE4COMPLETEDA Study Comparing the Withdrawal of Steroids or Tacrolimus in Kidney Transplant Recipients
NCT00195988PHASE4COMPLETEDComparison of Immunosuppression Protocols After LTx in Children
NCT00204191PHASE4UNKNOWNComparison of the Two Immunosuppressive Regimens Based on Tacrolimus and Cyclosporine Following Kidney Transplantation
NCT00223015PHASE4COMPLETEDInvestigation of the Steady State Pharmacokinetics of Tacrolimus, Mycophenolate Mofetil and Fluvastatin After Renal Transplantation
NCT00229138PHASE4COMPLETEDEfficacy and Safety of Enteric-Coated Mycophenolate Sodium (EC-MPS) in Kidney Transplant Recipients
NCT00252655PHASE4UNKNOWNUse of Sirolimus vs. Tacrolimus For African-American Renal Transplant Recipients
NCT00260208PHASE4TERMINATEDLiver Fibrosis in Patients Transplanted for Hepatitis C Receiving Either Cyclosporine Microemulsion or Tacrolimus
NCT00261820PHASE4COMPLETEDStudy Comparing Two Immunosuppressive Regimens in De Novo Renal Allograft Recipients
NCT00275535PHASE4COMPLETEDThe Comparison of Tacrolimus and Sirolimus Immunosuppression Based Drug Regimens in Kidney Transplant Recipients
NCT00290069PHASE4UNKNOWNRenal Function Optimization With Mycophenolate Mofetil (MMF) Immunosuppressor Regimes (ALHAMBRA)

Clinical evidence (CIViC)

No CIViC predictive evidence (expected for non-precision-medicine drugs).

Pharmacology

Pharmacogenomics

PharmGKB dosing guidelines (3) — CPIC / DPWG genotype-guided dosing for this drug (drug × pharmacogene):

GuidelineSourceGene(s)DosingRecommendation
Annotation of DPWG Guideline for tacrolimus and CYP3A5DPWGCYP3A5yesyes
Annotation of CPIC Guideline for tacrolimus and CYP3A5CPICCYP3A5yesyes
Annotation of RNPGx Guideline for tacrolimus and CYP3A4, CYP3A5RNPGxCYP3A4;CYP3A5yesyes

PharmGKB also curates 82 clinical and 1,127 variant annotation(s) for this drug (gene-keyed; see PharmGKB).

Molecules sharing ≥1 of this drug’s curated primary targets, merged from two biobtree sources and ranked by shared-target count, then clinical phase: ChEMBL clinical-stage candidates (development phase ≥2) and PubChem drug-class bioactivity (approved / known drugs acting on the target). Deduplicated by drug name; the drug’s own salt forms are excluded. Note: for a drug with few primary targets a shared-target match can reflect off-target / promiscuous binding rather than the same therapeutic mechanism — the phase ordering surfaces bona-fide therapeutics first.

23 molecules share ≥1 primary target. Top 23 by shared-target count:

MoleculeSourceStatusShared targets
CANNABIDIOLChEMBL + PubChemPhase 4 (approved)TRPM8
CAPSAICINChEMBL + PubChemPhase 4 (approved)TRPM8
CLOTRIMAZOLEChEMBL + PubChemPhase 4 (approved)TRPM8
DRONABINOLChEMBL + PubChemPhase 4 (approved)TRPM8
ECONAZOLEChEMBL + PubChemPhase 4 (approved)TRPM8
CYCLOSPORINEChEMBLPhase 4 (approved)FKBP1A
MENTHOLChEMBLPhase 4 (approved)TRPM8
SIROLIMUSChEMBLPhase 4 (approved)FKBP1A
THIABENDAZOLEChEMBLPhase 4 (approved)FKBP1A
ICILLINChEMBLPhase 3TRPM8
LEVOMENTHOLChEMBLPhase 3TRPM8
ACOLTREMONChEMBLPhase 2TRPM8
BIRICODARChEMBLPhase 2FKBP1A
CANNABIDIVARINChEMBLPhase 2TRPM8
CANNABIGEROLChEMBLPhase 2TRPM8
CYCLOHEXIMIDEChEMBLPhase 2FKBP1A
ELISMETREPChEMBLPhase 2TRPM8
SB-705498ChEMBLPhase 2TRPM8
TETRAHYDROCANNABIVARINChEMBLPhase 2TRPM8
eucalyptolPubChemApprovedTRPM8
EugenolPubChemApprovedTRPM8
menthol, unspecified formPubChemApprovedTRPM8
SerotoninPubChemApprovedTRPM8