Testing Tacrolimus level?

[EricaTO]

Does a tacrolimus blood test reflect the most recent dose only, or the tacrolimus build-up over a period of time? For example, if I take 2 tacrolimus pills at 8am, then take 1 pill the following 8pm, and get tested the next morning at 8am—will the test show my tacro level from 1 pill only? Sorry if this is confusing. I am supposed to take 5 + 4 pills daily, so wondering if the order in which I take them will make a difference in the lab test results.

[Darlenia]

My husband is under orders to never take tacrolimus in the morning before labs. He forgot once and was forced to repeat the labs without the morning dose. Apparently they're looking at what the existing prescription is doing to your numbers and taking that medication right before labs does skew everything. On the other hand, my husband has taken regular tacrolimus and timed-release tacrolimus and the protocols and outcomes didn't vary much, if at all. So I sense that they're interested in the aggregate impact of your full prescription, not the impact of just one tablet. So I suspect changing up the medication schedule doesn't really affect anything.

[EricaTO in reply to Darlenia]

Thanks. Yes, you can’t the pills before the lab work because the testis supposed be in the ‘trough,’ at the end of 12 hours after your last dose, thus showing your lowest blood level. My docs always ask me when I took the last dose before deciding if my levels are accurate. But it seems to me that if I take the higher dosage in the morning, then get tested the next morning at the end of a lower dose period, my blood would be lower than if I had been tested after the higher level.

[Darlenia in reply to EricaTO]

You may be on to something. I think I would ask my doctor if I could switch it up. Asking questions is generally free!

[Eyak1971]

I guess I am wondering why you are concerned. I too like others take a larger dose in the morning but the number on my test has to be between 5 and 7. That gives leeway for the results. I get tested once a month. So my dosage is changed at that time. So there is a period of time where the medication is constantly in my system. I would agree you need to contact your medical team. You need to build a relationship with them either by phone or email to get your questions answered. They have probably heard some that you have already wondered about. You need to be comfortable asking. We can try to answer with our limited knowledge and experience but your doctor is the best source. Google helps you to know what to ask but your doctor should be your primary source. Take care and enjoy your life with this special gift.

[EricaTO in reply to Eyak1971]

Thanks, good advice. I have a great team and am grateful for them

[PostivelyJo in reply to Eyak1971]

I’m curious . What’s the wisdom behind a higher dose in the morning ? I take the same dose twice a day

[Alfredmynewkidney]

I get mine tested about monthly. I take the once a day one and get my labs done just before I take my meds so it's the level at that time. Should be the lowest level.. the trough as someone mentioned. As long as you take them as directed I don't think it matters bigger dose morning or evening.

[littlelinda50]

They are testing to see if you have a therapeutic level in your system. They are checking to see how much is in your blood after 12 hours. So if you take them at 8am and 8pm the medication starts leaving your system at 12 hours that is why its given twice a day to keep a steady level in your system. Does this make sense at all?

[EricaTO in reply to littlelinda50]

Definitely. Thanks for your response.

[Lifechanger1]

I take my medications after my blood test is done, as per my doctor’s requirements.

[WYOAnne NKF Ambassador]

Double check with your doctor!Mine, had me do labs first thing in the morning before taking my medication - Neoral & Myfortic1. He wanted a "trough" level. Yes the medication does build up in your blood stream and usually doctor wants to see the level in your blood stream when it is at it's lowest. This is suppose to be the most accurate level or where you are at. This also gives him a good idea whether you are on the correct dose for you - whether the dose needs to be increased or reduces.

[BabyTee]

From the Prograf website: "Take PROGRAF with or without food, the same way every day. For example, if you choose to take PROGRAF with food, you should always take PROGRAF with food."

I didn't realize this, because the pharmacist (and the pharmacy pamplet) told me I could take it with or without food.

From the drugs.com website:

Food modifies how tacrolimus is absorbed, and therefore if you sometimes eat with and sometimes without food, it can raise or lower your trough levels.

Now I think that my tacrolimus levels fluctuating was because sometimes I would eat something near the time I took my prograf.

[PostivelyJo in reply to BabyTee]

I endeavour to take it without food or 2 hours after eating etc but sometimes ( hopefully) living gets in the way, a party or night out . My theory is try to take it within the same 30 minute period twice a day and don’t worry. Worth remembering that anxiety about things like this can cause huge problems as well …

[BabyTee in reply to PostivelyJo]

Agreed. Best not to stress too much. Sometimes my tac level was low and other times it was too high. I would have liked to know that there was a reason for it.

[PostivelyJo in reply to BabyTee]

It’s tough isn’t it. I wonder if perhaps we get too involved. The other day my lab results didn’t arrive as there had been an IT outage and in a way it was a relief. The drs had the results but not me, they’d have called if there had been a problem. I don’t know the answer

[AndrewT]

Dear EricaTO,

there are different 'Types' of Tacrolimus, which are Not directly interchangeable. The one that I am on is Advagraf, which is a Slow Release Capsule- so when a 'Tacrolimus Test' is required I take the Capsules as early as possible (around 7- 7:30 will do) the day Before the Test. I then do NOT take any Tacrolimus the morning of the Blood Test, however I take it Straight Afterwards. This ensures that only the Tac Level, actually IN my blood, is Tested. I'm sorry but I don't know, how 'other forms of Tacrolimus, are Tested, I'm afraid.

So to answer your question, yes ALL very Confusing, and also dependant on the TYPE of the Drug you take. However, I'm quite sure, that your Doctors/ Consultants WILL Know, all about You, Erica and will advise you accordingly.

Sorry that i can't be more 'Help' Erica.

AndrewT