The objective of this analysis was to assess the correlation between overall 24‐hour tacrolimus exposure, AUC 0–24 (area under the concentration–time curve
In the multivariate Cox analysis, after adjusting for related factors, a mean Tac level > 7 ng/ml was associated with an 86% decreased risk of AR compared with that of
The
THERAPEUTIC DRUG MONITORING Target levels: RIC Cy/Flu/TBI Haplo protocol: Aim for trough levels of 5-10ng/mL Other conditioning protocols: Aim for trough levels: 10
Tacrolimus requires individual dose titration to achieve a satisfactory balance between maximizing efficacy and mininimizing serious dose-related toxicity; Therapeutic drug
Therefore, therapeutic drug monitoring (TDM) is used to individualize TAC
Its use as a medicine is complicated by having a narrow therapeutic index and varying intra- and interindividual variabilities (Staatz and Tett, 2004)
Tacrolimus (TAC) has gradually replaced cyclosporine as CNI of choice due to its better potency and side effect profile
4% were found within the therapeutic range (5-10 ng/mL); 7
LAB ASSAY: Whole blood TAC and CsA samples are sent to VGH for processing using a tandem mass spectrometry assay
075 mg/kg orally every 12 hours
Monitor more frequently in people at higher risk of toxicity
THERAPEUTIC DRUG MONITORING Target levels: RIC Cy/Flu/TBI Haplo protocol: Aim for trough levels of 5-10ng/mL Other conditioning protocols: Aim for trough levels: 10-20ng/ml
Tell your doctor, specialist pharmacist or nurse specialist immediately if you have any of these symptoms while you PROGRAF (tacrolimus) injection, for intravenous use PROGRAF Granules (tacrolimus for oral suspension) •Frequent monitoring of trough concentrations is recommended
- See “Practical Guidelines for Tacrolimus and Cyclosporine Use” in white pages for information on AUC and dose adjustments - Monitoring may be less frequent if patient is stable
Tacrolimus is metabolised by the cytochrome P450 pathway, therefore drugs which affect the enzymes in this pathway may affect the tacrolimus concentration in the blood
For further advice on when to take blood samples and how to interpret the results, please contact your clinical pharmacist
The 2009 Kidney Disease: Improving Global Outcomes (KIDIGO) clinical practice guidelines for the care of kidney transplant recipients suggest monitoring sirolimus levels (2C)
A recent summary from an international proficiency-testing scheme demonstrated that the mass spectrometry respondents were the largest method group
2
4
May need to consider holding dose(s) in certain clinical scenarios Discuss with the ID consult a clinical pharmacist as needed