How do you protect the kidney from tacrolimus toxicity and damage?

I’m curious as to how you all can change your Tacrolimus maker. I have to use my company’s mail order pharmacy and they dispense Accord. I don’t have a choice to use any other maker since I’m required to use the mail order pharmacy. I’ve been taking the Accord Tacrolimus since 2019. Had my transplant (kidney) in December, 2009.

I started taking Prograf nearly 18 years ago for pancreas transplant. It was changed to the generic Tacrolimus because that was more cost effective. I haven’t paid attention to various “brands”. If you don’t mind sharing, why was it prescribed for you? Do you have a prescriber that monitors levels and adjusts your dose?

Your last post reminded me of a couple things. I now remember that my providers also had concerns about staying with the same brand when I switched from Prograf to generic Tacrolimus. We monitored drug levels and made dose adjustments to keep me at the desired range. That was a long time ago (almost 18 years). I used .5 mg capsules because it was easier to increase or decrease the dose as needed without wasting a quantity of higher strength medication. I settled into 1.5 mg (3 capsules) in the morning and 1 mg (2 capsules) in the evening. I get these from a “specialty pharmacy” affiliated with another mail order pharmacy that my Medicare plan approves. I just received a refill yesterday and noticed right away that the appearance had changed. They were yellow & white, slightly larger capsules than the tiny all yellow capsules I was expecting. Now that this is on my mind I saw that the brand had indeed changed. I’m nearly 18 years post transplant and have been told that the further out you are the risk of rejection becomes less but I’ve also heard that rejection can happen anytime. This transplant was my personal miracle and I’d sure hate to have a rejection episode now. So I’ve started using the refill.

In regards to toxicity from Tacrolimus I have some biopsy confirmed renal toxicity. I originally had a pancreas alone transplant in 2005. In 2016 I had pre-transplant evaluation for kidney. That is when the renal Tacrolimus toxicity was identified. I was using Accord brand I think. The refill I received yesterday is Sandoz.

I am exactly same here, got pancreas transplant and taking prograf
recently, my kidney got really bad ,,,,stage 3 B, GFR 31
Is your kindey ok?

I am afraid this is gonna be my case, i been tacrolimus for 18 yrs for pancreas tranplant, my kidney function got really bad,
Is that the only option or can we switch to another immune suppressant which is less toxic?

When I switched from Prograf to Tacrolimus I had to get my Drs to approve it and required some sort of documented statement. I wonder if switching brands presents a similar problem and solution. Do you have someone you can contact at the mail order pharmacy that can explain the requirements?

I didn't know prograf has more toxicity than Tacrolimus..
I thoughy one is generic and the other is brand.
Just do same thing

@pakyun22 you are correct. Prograf is the brand name. Tacrolimus is the generic name. Both are equally toxic to kidneys. I have been on both Prograf & Tacrolimus (first Prograf then switched to Tacrolimus) since my pancreas transplant 18 years ago. The damage to my kidney was discovered from a kidney biopsy much later. At some point I will need dialysis &/or kidney transplant because of my diabetes (not because of Prograf or Tacrolimus). Are you taking Prograf or Tacrolimus because of a pancreas transplant? Are you concerned about your kidney function?