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Prograf
tacrolimus
Black Box Warnings .
Malignancies and Serious Infections
incr. risk of serious infections and malignancies in pts receiving immunosuppressants may lead to hospitalization or death
Adult Dosing .
Dosage forms: CAP: 0.5 mg, 1 mg, 5 mg; GRANULE: 0.2 mg per pkt, 1 mg per pkt; INJ: various
Special Note
- [formulation clarification]
- Info: tacrolimus IR products not interchangeable w/ ER products; do not substitute on a mg to mg basis
heart transplant rejection prophylaxis
- [0.075 mg/kg/day PO divided q12h]
- Start: >6h post-transplant; Alt: 0.01 mg/kg/day IV infusion; Info: adjust dose based on serum levels
liver transplant rejection prophylaxis
- [0.1-0.15 mg/kg/day PO divided q12h]
- Start: >6h post-transplant; Alt: 0.03-0.05 mg/kg/day IV infusion; Info: adjust dose based on serum levels
kidney transplant rejection prophylaxis
- [0.1-0.2 mg/kg/day PO divided q12h]
- Start: w/in 24h post-transplant; delay if renal fxn not adequate; Alt: 0.03-0.05 mg/kg/day IV infusion; Info: adjust dose based on serum levels
lung transplant rejection prophylaxis
- [0.075 mg/kg/day PO divided q12h]
- Start: >6h post-transplant; Alt: 0.01-0.03 mg/kg/day IV infusion; Info: adjust dose based on serum levels; pts w/ cystic fibrosis may require higher doses
renal dosing
- [kidney transplant]
- renal impairment: give lowest recommended dose, may consider further dose decr.; postop oliguria: start 6-24h post-transplant; may delay until renal fxn adequate
- HD/PD: not defined
- [all other transplants]
- renal impairment: give lowest recommended dose, may consider further dose decr.
- HD/PD: not defined
hepatic dosing
- [see below]
- mild impairment: no adjustment; moderate impairment: not defined; severe impairment: consider decr. usual dose
Peds Dosing .
- Dosage forms: CAP: 0.5 mg, 1 mg, 5 mg; GRANULE: 0.2 mg per pkt, 1 mg per pkt; INJ: various
Special Note
- [formulation clarification]
- Info: tacrolimus IR products not interchangeable w/ ER products; do not substitute on a mg to mg basis
heart transplant rejection prophylaxis
- [0.3 mg/kg/day PO divided q12h]
- Start: >6h post-transplant; Alt: 0.1 mg/kg/day PO divided q12h if cell depleting induction tx given; Info: adjust dose based on serum levels
liver transplant rejection prophylaxis
- [PO route]
- Dose: 0.15-0.2 mg/kg/day cap PO divided q12h; Start: >6h post-transplant; Alt: 0.2 mg/kg/day granule PO divided q12h; Info: adjust dose based on serum levels
- [IV route]
- Dose: 0.03-0.05 mg/kg/day IV infusion; Start: >6h post-transplant; Info: adjust dose based on serum levels
kidney transplant rejection prophylaxis
- [0.3 mg/kg/day PO divided q12h]
- Start: w/in 24h post-transplant; delay if renal fxn not adequate; Info: adjust dose based on serum levels
lung transplant rejection prophylaxis
- [0.3 mg/kg/day PO divided q12h]
- Start: >6h post-transplant; Alt: 0.1 mg/kg/day PO divided q12h if cell depleting induction tx given; Info: adjust dose based on serum levels; pts w/ cystic fibrosis may require higher doses
renal dosing
- [kidney transplant]
- renal impairment: give lowest recommended dose, may consider further dose decr.; postop oliguria: start 6-24h post-transplant; may delay until renal fxn adequate
- HD/PD: not defined
- [all other transplants]
- renal impairment: give lowest recommended dose, may consider further dose decr.
- HD/PD: not defined
hepatic dosing
- [see below]
- mild impairment: no adjustment; moderate impairment: not defined; severe impairment: consider decr. usual dose