To retrospectively investigate the use of tacrolimus in patients with myasthenia gravis (MG) and compare it with that of azathioprine. Methods: Patients with MG who were given tacrolimus or azathioprine in our department between April 2008 and July 2016 were enrolled and evaluated for age, gender, course of disease, neurological status, antibody titer, treatment regimen, prognosis, and side effects. The Myasthenia Gravis Foundation of American (MGFA) post-intervention status was determined to evaluate the curative effect, with complete stable remission (CSR) being the optimal result. Results: A total of 290 MG patients who required immunosuppression were included in this study. Of these, 212 were given azathioprine (azathioprine group) and 78 were given tacrolimus (tacrolimus group). Azathioprine was more often used in treating new-onset patients (P=0.023). Compared to the azathioprine group, the tacrolimus group contained a greater proportion of patients over the age of 50 (P=0.012) and a smaller proportion of patients simultaneously using hormone treatment (P=0.022); the tacrolimus group achieved CSR in a shorter time (P=0.018) but showed no significant difference in the proportion of patients to reach CSR (P=0.113). Conclusion: Tacrolimus has fewer side effects and faster onset of action than azathioprine, but there was no statistically significant difference in their curative effect.