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dose cannot be administered orally as a result of the clinical condition of the patient, intravenous therapy of 0.01-0.05 mg/kg/day should be initiated as a continuous 24 hour infusion.Prophylaxis of transplant rejection - childrenAn initial oral dose of 0.30 mg/kg/day should be administered in two divided doses (e.g. morning and evening). If the clinical condition of the patient prevents oral dosing, an initial intravenous dose of 0.05 mg/kg/day should be administered as a continuous 24-hour infusion.Dose adjustment during post-transplant period in adults and childrenTacrolimus doses are usually reduced in the post-transplant period. It is possible in some cases to withdraw concomitant immunosuppressive therapy, leading to tacrolimus monotherapy.Post-transplant improvement in the condition of the patient may alter the pharmacokinetics of tacrolimus and may necessitate further dose adjustments.Rejection therapy – adults and childrenIncreased tacrolimus doses, supplemental corticosteroid therapy, and introduction of short courses of mono-/polyclonal antibodies have all been used to manage rejection episodes. If signs of toxicity are noted the dose of tacrolimus may need to be reduced.For conversion to tacrolimus, treatment should begin with the initial oral dose recommended for primary immunosuppression.For information on conversion from ciclosporin to tacrolimus, see below under “Dose adjustments in specific patient populations”.Dosage recommendations - Kidney transplantationProphylaxis of transplant rejection – adultsOral tacrolimus therapy should commence at 0.20-0.30 mg/kg/day administered as two divided doses (e.g. morning and evening). Administration should commence within 24 hours after the completion of surgery.If the dose cannot be administered orally as a result of the clinical condition of the patient, intravenous therapy of 0.05-0.10 mg/kg/day should be initiated as a continuous 24 hour infusion.Prophylaxis of transplant rejection – childrenAn initial oral dose of 0.30 mg/kg/day should be administered in two divided doses (e.g. morning and evening). If the clinical condition of the patient prevents oral dosing, an initial intravenous dose of 0.075–0.100 mg/kg/day should be administered as a continuous 24 hour infusion.Dose adjustment during post-transplant period in adults and childrenTacrolimus doses are usually reduced in the post-transplant period. It is possible in some cases to withdraw concomitant immunosuppressive therapy, leading to tacrolimus-based dual-therapy.Post-transplant improvement in the condition of the patient may alter the pharmacokinetics of tacrolimus and may necessitate further dose adjustments.Rejection therapy – adults and childrenIncreased tacrolimus doses, supplemental corticosteroid therapy, and introduction of short courses of mono-/polyclonal antibodies have all been used to manage rejection episodes. If signs of toxicity are noted the dose of tacrolimus may need to be reduced.For conversion to tacrolimus, treatment should begin with the initial oral dose recommended for primary immunosuppression.For information on conversion from ciclosporin to tacrolimus, see below under “Dose adjustments in specific patient populations”.Dosage recommendations - Heart transplantationProphylaxis of transplant rejection – adultsTacrolimus can be used with antibody induction (allowing for delayed start of tacr |
