How is tacrolimus administered

How is tacrolimus administered?

Tacrolimus can be given by mouth (PO), intravenously (IV), or sublingual. Oral dosing, when initially given in combination with MMF or MPA, is 0.1 mg/kg per day. It is important to know if the tacrolimus is immediate release (twice daily dosing) or extended release (once daily dosing); the ratio is 1:1. If IV tacrolimus is used the dose is 0.03 to 0.05 mg/kg per day by continuous infusion. The conversion ratio from oral dosing to IV dosing is roughly about 4:1. The maximum IV dose is 4 mg daily. However, the levels are difficult to follow and can be labile with IV dosing. Sublingual dosing is about 50% of oral dosing. If a patient is nothing by mouth (NPO), sublingual is preferable to IV dosing. In a situation where the patient cannot be appropriately dosed, the immunosuppression plan should be discussed with a transplant specialist.

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