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hello1234 (@hello1234)

Tacrolimus blood levels: Do yours vary?

Transplants | Last Active: Dec 31, 2022 | Replies (32)

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Hi @loribmt and @estrada53 😊
Thank you so much for sharing your Tacrolimis stories with me. Your details are always very helpful!
My current situation is the following. I tested positive for BK virus in August and I am still positive for BK but it's resolving nicely. My Cellcept (MMF) was reduced to 250mg bid.
My Tacronlimis target is 6 to 8. I have been testing for BK and TAC every two weeks. My Tac blood level has been 6.7, 6.8, 6.1, 5.8, 6.2, 7.0, 5.9 , 6.4, 5.5, 6.3 and my latest Tac was 5.2 (low). So most of the time, I am in the 6 to 8 range but every once in a while a "5. something" shows up.
I am wondering if what I am eating for breakfast may be affecting the number….Or maybe my timing of the dose if I run 15 or 30 minutes late taking my pills. Do you ever run late for your pills?
While trying to resolve the Bk virus infection, I assume being at the low range of 6 is best. So I am not excited about the idea of increasing my dosage, but I don't want to put myself in danger of rejection either. I am hopeful to not take more Tac if possible. Since I have always taken my meds with food, I didn't know if my results may be more reliable with no food. If I have another 5.2 this week then I will need to increase my Tac dosage to assure I am reaching the 6 to 8.

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Replies to "Hi @loribmt and @estrada53 😊 Thank you so much for sharing your Tacrolimis stories with me...."

Since the BK is responding nicely to the lowering of the Cellcept, allowing your immune system to get the virus under control, it’s not likely you’re going to have an increase in the Tacro dosage to compensate. That would defeat the purpose. It would again increase your immunosuppressant level and slow the immune system down. Your doctor lowered the Cellcept to ‘unleash the hounds’ of defense. ☺️ Of course, it is a balancing act between defending against the virus and protecting the transplant. So your doctor’s will be following the other blood numbers too, not just tacro.

Some foods and meds, such as grapefruit or pomegranate juice can increase the amount of tacro in the body and other meds can cause it to be processed through faster. Your numbers don’t look alarming from my experience. I had fluctuations too and most of them could be explained by timing on the tests and if I was late for a dosage. Your tacro numbers might even be affected by the decrease in your Cellcept. That’s another variable that’s changed besides the BK. As an example, I had a med swap from IV form to capsule form of a medication about 2 months after transplant. My trough level of 7 had shot up to a whopping 22.6 in a matter of days. The new med interfered with processing the tacro out of my body so toxic levels built up rapidly. So it shows how med interactions play a role with each other.

Consistency is really important especially since you’re on 2 anti-rejection meds and one has been reduced to control the BKV.
Your team is monitoring you closely. If there’s an issue they’ll let you know. Relax and enjoy the holidays! ☺️