what is tacrolimus
anti-rejection psot trnasp;ant, atopic eczema
mode of action
inhibition of cytokien production, invovled in the regualtion fo t cell activation part of the immuen resosne
patients of black africam or aftriacan carribean family origin may require a higehr dose
mhra alert
adoport and prograf are immediate relief taken twice a day
modigraf granules used to prepeare an imemdiate reease oral suspension taken twice daily - once in mornign and once in the evening
advagraf and dalliport - prolonged rleease cpasules taken once daily in the morning
switching between tacrolimus brands requires careful supervision adn therapuetic monitorign by an appropriate specilsit
envarsus is not interchangeable twth other tacrlimus contanign products
what are side effects tacrolimus?
common - myelosuppression, increased risk of infection, sensation abnormal reactions, hyperglycaemia, hypertension, renal and heaptic dysfucntion, skin cancer and lung cancer - frewuwncy unknown, eye disorders and cardiomyopathy.
what are monitoring requirements of tacrolimus?
monitoring tacrolimus trough cocnetrations, blood pressure, heaptic fucntion, renal fucntion
Can it be used in pregnancy ?
exclude preganacy before treatment. maternal risk of hyperglycaemia, hypertesnion, pre-eclampsia and renal impairment.
what does tacrolimus interact with?
- antifungals
- ciclosporin
- NSAIDs
- anticoagulants
- icnrease atc-blood levels
what are counselling points of tacrlimus
- cousnellign specialist for fever, sore throat, flu-liek symptoms, unexplained bruising or bleeding, yellowign skin/eyes. avoid excess exposure to UV light inclsuing sunlight. use sunscreen, chceck your skin for new spots, freckles, or moles, report eye disorders for prompt evaluation by an opthalmologist
suammru of immunosuppresants
azathiopurine - TPMT elvels
mycophenolate - diarrhoea is common, not equivalent to mycophenolci caicd
ciclosporin - monitor levels, brand-specific, nephrotoxicity, non-myelotic
tacrolimus - monitor triugh elvels, brand-specific, cardiomyopathy
all of the immunosuppresant drugs can cause an icnreased risk of infection so patients should be couselled on this and avoid live vaccines. These meds may need holdign during acute infections. patietns should be advised to use SPF, check for new spots on skin and avoid excess UV light exposure (photosesitivity/ melanoma)
all should be avoided in preganacy, if possible (risk v beenfit) would be specislit decision
all except ciclosporin can cause bone marrow suppression. cousnel pateitns on red flag symptoms. increased risk of developing cancer.
