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Change in Tacrolimus trough level with change in manufacturer?

Posted by caretakermom @caretakermom, Jul 16 7:20pm

My husband gets his Tacrolimus from CVS Specialty Pharmacy mail order. Recently CVS Specialty stopped supplying Tacrolimus manufactured by Ascend, now getting supplies from Biocom. I have heard this change was made due to a shortage in supply. Husbnad has been using the drugs from Biocom for 2 weeks now and today his Tac lab came back lower than the recommended range. Curios to know if anyone have had their Tac trough level effected by a change in manufacturer? Looking forward to your inputs.

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Rosemary, Volunteer Mentor | @rosemarya | Jul 17 7:12pm

@caretakermom, Tacrolimus trough level can be affected when it is manufactured by another Company. I get my immunosuppressant medications through the Mayo Specialty Pharmacy, and I remember getting a notification via the patient portal about it once. I was alerted that it sometimes resulted in an elevated trough level in some patients. And that I should talk to my transplant team if I noticed such a change. I did not, however, notice any significant change in tacrolimus level or any of my routing labs that are always drawn at the same time.
Each of us processes our meds differently. I commend you for reaching out to others about this issue. Caretakermom, I think that you will want to bring this matter up with your husband's doctor who is prescribing and monitoring his post transplant care. Does that sound like something you can do?

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caretakermom | @caretakermom | Jul 17 9:38pm
In reply to @rosemarya "@caretakermom, Tacrolimus trough level can be affected when it is manufactured by another Company. I get..." + (show)
@rosemarya

@caretakermom, Tacrolimus trough level can be affected when it is manufactured by another Company. I get my immunosuppressant medications through the Mayo Specialty Pharmacy, and I remember getting a notification via the patient portal about it once. I was alerted that it sometimes resulted in an elevated trough level in some patients. And that I should talk to my transplant team if I noticed such a change. I did not, however, notice any significant change in tacrolimus level or any of my routing labs that are always drawn at the same time.
Each of us processes our meds differently. I commend you for reaching out to others about this issue. Caretakermom, I think that you will want to bring this matter up with your husband's doctor who is prescribing and monitoring his post transplant care. Does that sound like something you can do?

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@rosemarya

Thank you for your response. We're are here now in Mayo Clinic Az for husband's 2 year post transplant checkup. Did blood work on Tuesday morning and the results came back show Tac is below recommended range by 0.2. Different labs can produce different values too, at home we use Quest. Previous to manufacturer change (from Ascend to Biocom), his Tac trough level was in range and I knew that as soon as I found out this change that there is real possibility husband may need to have his Tac dosage adjusted. Already told local neph that so he is aware. We will meet with the Mayo transplant neph tomorrow and discuss about it. Mayo will probably
tell us to work with our local nephrologist to adjust the dosage. Hopefully the Mayo transplant neph can perhaps coordinate with our local neph in adjusting husband's Tac.
Changing the subject now that I have your attention, did your transplant team ever order Cystatin C eGFR labs at your check up? I read that is 96% accurate in measuring kidney function but having diabetes may effect the value. Husband has a very low eGFR with this test so I'm very concerned. All his other labs look pretty good except for the Cystatin C eGFR!! Will definitely ask doctor abut this lab. I don't think our local neph is not familiar with this lab either.

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