How do you protect the kidney from tacrolimus toxicity and damage?
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I am post liver transplant three years. Life is good with no problems. I rake Tacrolimus. I was told by my transplant doctor that Tacrolimus is toxic to your kidneys. However, you need it yo prevent rejection. The mandatory scheduled lab tests are to check the serum blood levels of the rejection drugs. I happen to be on 5 pills a day which causes my kidney creatine to be elevated slightly above listed average levels on the lab tests. I was told that it is very common for liver transplant recipients to be in need of a kidney transplant in time. Possibly 20 years I think. But, the good news is we are all alive. Drink plenty of water to prevent a unneeded build up of the drug in your system. The build up is what increases the toxic nature of the drug. When my kidneys where weak just after my transplant. I was on cellcept, its easier on the kidneys. God Bless.
Drink plenty of water and try to stay as close to the bottom of the recommended blood serum count as is recommended on your lab test.
I have been taking Accord brand of Tacrolimus for a couple of years today I got a call from CVS speciality pharmacy that they are no longer dispensing accord brand
Here is the FDA url:
I am switching over to Ascent brand, If any you have suggestions or long term experiences with any particular brand .. please share... Thanks
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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?
Initially: after the transplant .. I never paid any attention to the generic brands, until the Tacro levels started fluctuating drastically .. when a Dr Reddy brand was delivered by CVS speciality, - brought this to Doctors attention and it was recommended to keep the brand constant - I was surprised that the levels were more steady. ( I mentioned this my transplant center .. they confirmed ...stick to a brand.
In this case (accord tacrolimus) the FDA has found that toxicity caused by Accord Tacrolimus has higher than normal toxicity but it is able to maintain the Tacrolimus levels. ...
My dose is 1.5mg per day (it hasn't been adjusted over the last 3 years)
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.
Yes I was asked by my Xplant center to switch to Sandoz too.. Thanks for sharing.
When you switched over to Sandoz, Did the trough levels of the Tacrolimus remain around the same as Accord
Neil, I don’t know yet. Just started the Sandoz a few days ago.My post transplant labs are now only every 3 - 6 months. I get them done about a week before an office visit with my provider. My next appointment is in November and I’ll know then. The levels have been really stable and my dose hasn’t changed in a really long time. That has been the goal for nearly 18 years. Thank God it seems to be the case. Have you switched to Sandoz?
Thanks Cheryl for the update,
Month of Oct I will be taking Accord, but starting Nov it will be Sandoz, Seeing the Dr in last week of Oct I will ask the Dr to test tacro levels after 30 days.
FDA paper states that switching from "Accord to Sandoz "should not alter the Trough Levels, we shall soon find out.
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