Tacrolimus Dosage

[sugabear]

My husband has been taking 3 mgs of Envarsus for about a year or so. Right at his three-year anniversary appointment, they increased it to four because his tacrolimus levels have been consistently under 5 for three months. What's odd about this is that back in December, he received a letter from the transplant clinic stating they wanted his levels between 3 and 5, so we thought he was right on track.

I'm curious about other people's experiences. Yes, we are listening to doctors. If you take tacrolimus, how much do you take daily and which brand (prograf, envarsus, etc.)?

[Winner76]

Hi ,

I take 1mg of Prograf twice daily since the beginning nearly. Go with what your doctor said because as far as I’m aware below 5 is low.

[DexterLab]

I take 2 mg of Prograf twice a day. Got to that level about 6 months after transplant. My tacro levels are generally 6-7. The note on the test results says the usual range is 3-8, well after transplant.

[littlelinda50]

I take Prograf 2 mg AM and 2 mg PM. I would mention the letter and ask why now are they changing what they said they want the level to be now. Sometimes it can depend on how your creatinine and bun levels are on what they want your tacrolimus level to be. It took me a year to get my transplant center to tell me what they wanted my level to be like it was some big secret. I definitely would ask and make sure they give you a clear explanation. Good luck

[sugabear in reply to littlelinda50]

I called the clinic and after some research, they realize that the letter they sent out was wrong. They want him between five and seven because of the Campath induction he received at the time of transplant. It’s annoying that the letter was incorrect,

[littlelinda50 in reply to sugabear]

That sounds like something my transplant center would do! I am a Medical Assistant and needed a letter saying giving live vaccines is not safe. I was told just don't get stuck! I said have you ever given a infant or child a vaccine they don't always stay still and the parents sometimes loose their grip on them.

[sugabear in reply to littlelinda50]

How frustrating! I hope you finally got the letter.

[Steph1957]

Hi, I currently take 1 1/2 mg. prograff twice daily. I am only 4 1/2 months post transplant with a target of 6-9. My level has been right around 7. Good luck.

[VeroBeachTransplant]

Mine started out at 4 mg total daily and was decreased quickly (less than a year) to 2 mg, where it has remained for 12 years now. These dosages were split between AM and PM.

[Sunnydaylove]

I was on prograf for 3 months before kidney transplant and continued for 3 months after. I just recently switched to envarsus. Tac levels went to 3 on 2 mg, and then 9 on 3 mg. Now on 2.5 mg. and I am at 7. 7 is ok with the doc. Switched from prograf to envarsus to see if it would help with shortness of breath, it did not help, what did change is my tremors have disappeared. I sleep so much better too.

[dmteacher]

I take 3mg of Envarius and keep the level between 4-6. I had my transplant 18 years ago.

[Darlenia]

My husband takes 2 mgs of Envarsus once daily. His trough levels are good (normal). Prescriptions can vary depending on one's weight, other drugs you're on, etc. They're tailored to each individual. Hubby is almost 4 years post transplant. It's very good idea to keep an eye on labs and trends.

[sugabear in reply to Darlenia]

What range do they want him in?

My husband's labs have been great other than the tacrolimus levels. I just hate changing things.

[Darlenia in reply to sugabear]

In my husband's last report, his trough level was 5.3 for Envarsus, a time-release version of tacrolimus. For those taking Envarsus, levels of 4-11 are normal. If one takes standard tacrolimus, the trough level should be between 5-10. Trough level indicates the amount of medication in the blood stream. If it's too low, kidney rejection increases significantly. A review of your husband's prior labs will give you a good sense of what's happening and the reason why his immunosuppressant is being increased. Hope this helps!

[JackN]

I'm sure you're doing this but just in case, my prograf labs require to skip it the morning of the test. I assume your husband should be doing the same. Just a friendly reminder, good luck figuring it out!

[sugabear in reply to JackN]

Thanks for the reminder! He does not take any medication before his labs. We spoke with the clinic again and they notified us that the letter they mailed out was incorrect and that his trough level should be between five and seven. I’m glad we got an answer.

[Darlenia in reply to sugabear]

Ooh..I'd be sooo upset to be put through that! Glad you were proactive and caught it! Medical professionals should have done that. Smh.

[TeacherMommy]

Glad you got to the bottom of it. Good job advocating!

It is interesting how different people’s doses are to get to the target level. My transplant nephrologist said that their target trough was 8 at first, but now that I am a few years out they are ok with 6. Of course, as people have said here everything depends on everything else, so some of their calculation has been the levels of other medications, any signs of rejection, side effects, etc. I forgot to ask about target levels last time I was there - thanks for the reminder.

I love the “trends” feature in my patient portal - it is so helpful to see the results in the context of trends. Helps me not to get too anxious when I see variations.

Best wishes to everyone for good health!

[CA_Coast]

Envarsus 2mg daily. It’s been up from that , then down. My target is 5-7. 5 years out

[Herewegoagain12]

I've been taking tacrolimus for 9 years. Was it liver transplant or kidney?

[sugabear in reply to Herewegoagain12]

Kidney

[Dmarlo]

it really depends on the doctor, how you metabolize the drug, and how far you are out from transplant. So, many doctors want to run the average a little higher in folks they feel maybe more likely to reject. You are at higher risk of rejection in the first 1-3 years, so "recommended level typically decreases over the years." Also, envarsus is not metabolized the same as regular tacrolimus. Its extended-release tacrolimus, so you're taking it once a day, the level is often run a little higher to make sure you're not getting low / non-therapeutic as it "wears off". How ever, if you get increased side effects (tremors) report to your team. you can always ask about the "rationale", of their prescribing higher dose, and if the nurse doesn't know, ask her to find out. That is not rude, its being proactive.

[sugabear in reply to Dmarlo]

You gave us more information than his transplant team has, so thank you!