Kidney transplantation Primary immunosuppression – adult patients who have not carried out basic therapy (aimed at stimulating production of antibodies) testosterone suspension side effects oral therapy should be started with a dosage of 0.30 mg / kg / day, dividing the dose into two doses (eg morning and evening) drug therapy should be initiated approximately 24 hours after completion of the operation. patients receiving standard treatment, it is recommended to start the oral administration of the drug with the dosage of 0.20 mg / kg / day, dividing it into two doses (eg morning and evening). If the patient’s condition does not allow to take the drug inside, intravenous therapy must begin with a dosage of 0.05 – 0.10 mg / kg / day by injecting a drug by intravenous infusion over 24 hours.
Initial immunosuppression – children Before surgery drug administered to children in dosages 0, 15 mg / kg for oral administration. After the operation should be carried out in the intravenous therapy with a dose of 0.075 – 0.100 mg / kg / day, dropwise, during 24 hours, until the patient can not take the drug inside, then to assign oral drug therapy in the initial dosage of 0.30 mg / kg / day, divided into two doses. maintenance therapy – adults and children during maintenance therapy dosage usually fall. In some cases, you may cancel the drugs concomitant immunosuppressive therapy, leaving as the base alone. Improving the condition of the patient after the transplant may alter the pharmacokinetics of tacrolimus, and there will be a need for correction of the dose. In general, the drug dosing principle should be based on the results of the clinical assessment of rejection and tolerability of the process each individual patient. If clinical signs of rejection are evident, it is necessary to consider changing the mode of immunosuppressive therapy. In order to achieve similar levels of drug in the blood, the children are usually required dosage is 1.5-2 times higher than the dose for adults. Treatment of rejection reaction -. Adults and children for treatment of rejection episodes was carried out increasing the dosage testosterone suspension side effects, appoint additional glucocorticosteroid therapy, and introduction of short courses of mono- / polyclonal antibodies. If signs of toxicity may require dose reduction of . For information on the transfer of patients on cyclosporine therapy see guidance at the end of this section, “Adjusting the dose of the drug in specific patient populations”.
The rejection of the heart transplant original rejection therapy The initial dose for oral administration of 0.30 mg / kg / day, to be divided into two doses (eg morning and evening). If the clinical condition of the patient does not allow him to take medication by mouth, should begin therapy with intravenous dosing of 0.05 mg / kg / day, drip by injecting the drug within 24 hours
Adjusting the dose at distinct populations of patients Patients with liver failure: patients with severe liver failure dose reduction may be required to maintain a minimum level of drug in the suggested gradations. Patients with renal insufficiency: since the pharmacokinetics of tacrolimus is not changed depending on renal function It does not require dose adjustments. However, due to the presence of tacrolimus nephrotoxicity should carefully monitor renal function (including the concentration of serum creatinine, creatinine clearance, and the level of urine output). Elderly patients: there are currently no evidence of the need to adjust the dose for elderly patients.
Translation from cyclosporin therapy: concomitant use of cyclosporin and can increase the half-life of cyclosporin and increase toxic effects. Therefore, care must be taken when transferring patients to therapy with cyclosporine . Treatment should begin after the assessment of concentrations of cyclosporine in the blood of the patient and the patient’s clinical condition. Use of the drug should be deferred in the presence of elevated levels of cyclosporine in the blood of the patient. In practice, treatmenttestosterone suspension side effects started 12-24 hours after discontinuation of ciclosporin. Therapy should begin with the initial oral dosage recommended for primary immunosuppression in particular allograft (both in adults and in children). After the transfer of the patient is necessary to continue to monitor cyclosporine levels in the blood of the patient in connection with disturbances in the clearance of cyclosporine.
Recommendations for achieving required level of drug concentration in whole blood. in the early period after surgery should be controlled to minimum levels of tacrolimus whole blood. When oral administration to determine the minimum blood levels of the drug necessary to obtain blood samples 12 hours after drug administration, directly before the application of the next dose. The frequency of monitoring blood levels will depend on the clinical need. Since the drug is testosterone suspension side effects may take several days with low clearance adjustment dosing regimen before the time when the change in blood drug levels will be apparent. The minimum blood levels of the drug should be controlled approximately twice a week during the early post-transplant period and then periodically during maintenance therapy. It is also necessary to control the minimum levels of tacrolimus in the blood after changing the dose changes immunosuppressive mode or after the combined use with drugs that may affect tacrolimus concentration in whole blood. The results of the analysis of clinical studies suggest that it is possible to successfully treat most patients, if the minimum tacrolimus in the blood levels are maintained below 20 ng / ml. in clinical practice in the early period after transplantation minimum levels in the whole blood preparation is typically varied from 5-20 ng / ml in liver transplant recipients and 10-20 ng / ml in patients with a kidney transplant. Therefore, during maintenance therapy the drug concentration in the blood should be 5-15 ng / ml as liver transplant recipients, and kidney transplant.