When do you monitor tacrolimus level?
The test is performed when dosages are changed and whenever patients have symptoms that suggest side effects, toxicity or organ rejection. Monitoring at intervals is necessary as long as the patient is taking tacrolimus.
Does tacrolimus require therapeutic drug monitoring?
Tacrolimus requires diligent therapeutic drug monitoring (TDM) to maintain appropriate serum concentrations after transplant.
What are symptoms of tacrolimus toxicity?
Three patients were asymptomatic after accidental overdose, whereas seven individuals exhibited mild, transient signs and symptoms; these included mild elevations of renal function markers (blood urea nitrogen and creatinine), nausea, mild hand tremors, and elevations of liver enzymes.
What is a normal tacrolimus level after kidney transplant?
Generally, the tacrolimus trough level maintained between 5.35 and 7.15 ng/mL may be optimal during the first month after living relative kidney transplantation among the Chinese.
When do you draw a tacrolimus trough?
For cyclosporine or tacrolimus trough-level monitoring, blood should be drawn 12 h after the last dose (i.e., immediately before the next dose).
What is the normal tacrolimus level?
Most individuals display optimal response to tacrolimus with trough whole blood levels of 5.0 to 15.0 ng/mL. Preferred therapeutic ranges may vary by transplant type, protocol, and comedications.
How is tacrolimus monitored?
Like cyclosporine, tacrolimus monitoring should be done with whole-blood samples (16). Its half-life is 12 to 18 h, which suggests that a period of approximately 2.5 d should elapse to assess the effect of a dosage adjustment on the tacrolimus level.
What is tacrolimus toxicity?
Tacrolimus toxicity commonly presents as acute renal failure. Close monitoring of serum creatinine, GFR, and urine output is necessary for patients on tacrolimus. Toxicity may also present as the development of adverse effects such as tremors, electrolyte disturbances, headaches, and increased SCr.
Is tacrolimus immunosuppressant?
Tacrolimus (Prograf ®) is an immunosuppressant drug used to prevent and treat organ rejection in children who have had liver transplants. It is used for long-term immunosuppression.
What can affect tacrolimus levels?
The pharmacokinetics of tacrolimus are influenced by many factors, including genetic variability, acute infections, liver dysfunction, and interacting medications, which can result in elevated concentrations.
What is a good tacrolimus level?
What is considered high tacrolimus level?
Tacrolimus trough levels higher than 6 ng/mL might not be required after a year in stable kidney transplant recipients.
Why is trough level monitoring of tacrolimus important?
Trough-level monitoring of tacrolimus has been standard practice since its introduction. Similar to cyclosporine, achieving early adequate tacrolimus exposure significantly reduces the risk for acute rejection.
When do you draw tacrolimus for drug monitoring?
Trough blood tacrolimus concentrations are almost exclusively used for routine monitoring and are believed to be a good indicator of total drug exposure (101). However, recent experience with CsA has challenged this notion, and alternative draw times 1-6 h after dosing have been proposed (102).
How is tacrolimus measured in an organ transplant program?
Methods of Analysis Monitoring of tacrolimus is an integral part of any organ transplant program because of variable dose-to-blood concentrations and the narrow therapeutic index. Tacrolimus can be measured using enzyme-linked immunosorbent assay (ELISA), semi-automated and automated immunoassay, and HPLC-MS (Table 6).
What is the pharmacokinetic profile of modified release tacrolimus?
Modified-release tacrolimus was shown to have an equivalent pharmacokinetic profile in stable patients who were converted from standard tacrolimus in a 1:1 manner ( 20 ). Target trough levels for modified-release tacrolimus seem to be the same as for standard tacrolimus in both de novo and maintenance patients ( 21 ).