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.