Thursday, June 24, 2010

Thursday June 24, 2010
On Prograf 'Trough' level


Prograf (FK 506,Tacrolimus) is a commonly used medicine in transplant patients and its level should be monitored closely. It is important to draw prograf level (preferably written as order) just before dose of next medication (lowest or "trough" blood level). Dosage should be adjusted based on the trough levels of medication. Normal trough level is 5-15 ng/ml.

Important interactions to be aware of in these potentially immunosupressed patients are with antifungals, especially of the azole class (fluconazole, posaconazole). They increase drug levels by competing for degradative enzymes. Diltiazem can also dramatically increase tacrolimus concentrations and result in tacrolimus toxicity. Other drug interactions are common too.

Prograf toxicity may cause blurred vision, liver and renal failure, tremors, hyperkalemia, hypomagnesemia, and neurological problems such as seizure, encephalopathy, cerebral edema, confusion etc.