Tacromax Dosage/Direction for Use

Dosage recommendations liver transplantation: It is recommended that patients initiate oral therapy with Tacrolimus (Tacromax) capsules if possible. If IV therapy is necessary, conversion from IV to oral TACROLIMUS (TACROMAX) is recommended as soon as oral therapy can be tolerated. This usually occurs within 2-3 days. The initial dose of Tacrolimus (Tacromax) should be administered no sooner than 6 hours after transplantation. In a patient receiving an IV infusion, the first dose of oral therapy should be given 8-12 hours after discontinuing the IV infusion. The recommended starting oral dose of Tacrolimus (Tacromax) capsules is 0.10 to 0.15 mg/kg/day administered in two divided daily doses every 12 hours. Co-administered grapefruit juice has been reported to increase tacrolimus blood trough concentrations in liver transplant patients.
Dosage recommendations kidney transplantation: The recommended starting oral dose of Tacrolimus (Tacromax) (administered every 12 hours in two divided doses) is 0.2 mg/kg/day when used in combination with azathioprine or 0.1 mg/kg/day when used in combination with MMF and IL-2 receptor antagonist. The initial dose of Tacrolimus (Tacromax) may be administered within 24 hours of transplantation, but should be delayed until renal function has recovered (as indicated for example by a serum creatinine ≤ 4 mg/dL). Black patients may require higher doses to achieve comparable blood concentrations.
Patients with heart transplantation: The recommended starting oral dose of Tacrolimus (Tacromax) is 0.075 mg/kg/day administered every 12 hours in two divided doses. If possible, initiating oral therapy with Tacrolimus (Tacromax) capsules is recommended. If IV therapy is necessary, conversion from IV to oral Tacrolimus (Tacromax) is recommended as soon as oral therapy can be tolerated. This usually occurs within 2-3 days. The initial dose of Tacrolimus (Tacromax) should be administered no sooner than 6 hours after transplantation. In a patient receiving an IV infusion, the first dose of oral therapy should be given 8-12 hours after discontinuing the IV infusion.
Dosing should be titrated based on clinical assessments of rejection and tolerability. Lower Tacrolimus (Tacromax) dosages may be sufficient as maintenance therapy. Adjunct therapy with adrenal corticosteroids is recommended early post transplant.
Pediatric patients: Pediatric liver transplantation patients without pre-existing renal or hepatic dysfunction have required and tolerated higher doses than adults to achieve similar blood concentrations. Therefore, it is recommended that therapy be initiated in pediatric patients at a starting IV dose of 0.03-0.05 mg/kg/day and a starting oral dose of 0.15-0.20 mg/kg/day. Dose adjustments may be required. Experience in pediatric kidney and heart transplantation patients is limited.
Patients with Hepatic or Renal Dysfunction: Due to the reduced clearance and prolonged half-life, patients with severe hepatic impairment (Pugh ≥ 10) may require lower doses of Tacrolimus (Tacromax). Close monitoring of blood concentrations is warranted.
Due to the potential for nephrotoxicity, patients with renal or hepatic impairment should receive doses at the lowest value of the recommended IV and oral dosing ranges. Further reductions in dose below these ranges may be required. Tacrolimus (Tacromax) therapy usually should be delayed up to 48 hours or longer in patients with post operative oliguria.
Conversion from One Immunosuppressive Regimen to Another: Tacrolimus (Tacromax) should not be used simultaneously with cyclosporine. Tacrolimus (Tacromax) or cyclosporine should be discontinued at least 24 hours before initiating the other. In the presence of elevated Tacrolimus (Tacromax) or cyclosporine concentrations, dosing with the other drug usually should be further delayed.