Fast Tacrolimus Metabolism?

Hi @2gallonhabit
I'm a heart transplant recipient and right after tx, my doctors told me I was metabolizing tacro as if I were a 21 year old male athlete. I was 63 at the time.
My dosage was altered but the main culprit was a med I had to take for my thyroid.
Eventually after a year and 7 months, I was switched to sirolimus as the tacro was negatively affecting my kidneys.
I hope you get the answers you're looking for when you see your team.

@estrada53 Super interesting - thank you! Were you on levothyroxine by any chance (hypothyroid)? I just received a kidney transplant so I'm paricularly concerned about tacro's effect. Best wishes to you. Have a great New Year!

Hi @2gallonhabit 😊
Very nice to meet you! I am a two year post kidney transplant patient. I take 6mg Envarsus XR (Tacrolimis) to achieve a target range between 6 and 8. I take my meds with food to avoid stomach upset. What is your current Tacrolimis dosage and target range? Are you labs coming back with a low Tac level?

Hello @hello1234! Right now I'm on 6mg of tacrolimus 2x/day and am at a trough level of 7. I believe my target level is between 8 and 10. My creatinine alreafy took an 18 point hit going up to that level from 4 mg 2x/ day so I fear what will happen with another increase in meds.

@2gallonhabit Congrats on your kidney transplant.
I was actually hyperthyroid, not hypo. I was taking methimazole.
Here's to a happy and healthy 2023!

Hi @2gallonhabit 😊
Are you a new transplant? I am a two year post kidney transplant patient. In the beginning, my Tac number was all over the place. It was targetted for 8 to 10 in the first year and I had very low scores and then a score of 19. My Tac was adjusted daily in the beginning. Now that two years has passed, I find that my number is very sensitive to what I eat. I have scores of 5 and then the next week 7. Of course, 5 is out of range and 7 is good. I am fighting the BK virus, so I like to see numbers like 6 instead of 8. My BK virus number is better when the Tac is on the lower end of the range so my immune system can see the infection (but hopefully not the kidney!). Is it possible that something you are eating is affecting the number (high fat, etc) Do you take your meds with food?
I have seen many transplant patients on Connect that successfully take Sirolimus so hopefully they will jump in and share their experiences. (I am pretty sure that @caretakermom hubby may have recently started Sirolimus and I have seen others). So if they decide to change you to Sirolimus, I don't think you will have any problems, but maybe the Sirolimus folks can give you their personal experiences.

Hello,
On February 10th I will be two years post transplant and still take 4 Tac in the morning and 3 Tac at night. They want my labs between 5-7. Last labs came in at 6.3.
Good luck at your appointment.

@firecat 😊
Do you take your meds with or without food?

I take my my all my meds with food at 9 AM. Evening meds about 5 PM except Tac at 9 to keep dosage at 12 hours apart. 4 Tac in morning and 3 at night. I hope things will soon settle out for you.

Thanks so much @firecat 😊
I really appreciate all the details. I take my meds with food just like you. I should get my new Tac blood level results back today or tomorrow. Hopefully, the number is back in range!