Secondly , in my sorrounding there is an opinion that lowering the TACROLIMUS dose also let the liver enzymes to increase? Do you favour such opinions as my father has lowered his tacrolimus dose to keep his kidneys safe?
Sir ,will wait for your kind reply.
Thanks.
i wouldnt lower the tacrolimus dose further
The following medicines may increase the level of tacrolimus in the blood, which could increase the risk of side effects.
I'm geno type 3. I've heard Prograf is harder on the kidneys than sirolimus which is why they switched me from cyclosporine to sirolimus. That's probably why they haven't suggested switching me to Prograf in fact this is the first time I'm hearing about Prograf or Tacrolimus (it's other name as I found on the web). Thanks for your response and congrats on your great report since week 4 !
there are prograf assistance programs that the company offers. If this is not feasible than using other cheaper medications such as verapamil for example for HTN for example will alllow much lower doses of prograf to be used (it delays metabolism of the medication) and thus it comes out cheaper.
the new medications may affect the dose of prograf dramatically, possibly up to 70%. this might make it difficult to control the levels and predispose the person to rejection or renal failure. there are very early studies looking at this. our center is not starting patients on therapy except if someone has a fulminant course of recurrence until more data are available. i am sure that other centers however will embrace the new meds and will be actively treating patients with them.
I think you should go on with systemic corticosteroids and newer modes of intervention like topical tacrolimus and pimecrolimus (an immunosuppressant known as a topical immuno-modulator) are new agents. These medicines are used if patients are intolerant or unresponsive to conventional therapy.
Weak tar preparations and ultraviolet B light therapy are used to increase the thickness of the stratum corneum.
Keep me informed if you have any queries.
i would definitely dramatically lower your prograf dose. often we leave people on very small doses of prograf (such as 0.5mg BID) just to offset any possibility of rejection. We have several patients who are maintained on rapa monotherapy without a problem. rapa at times can be difficult to tolerate--i agree with the current recommendations being given to you.
t understand the relationship between treatment and Prograf dose. It sounds logical to think that the higher the Prograf dose the less likely TX will be successful and, at the extreme, I think that's probably true. But, whether 3 mg per day or 6 mg Prograf per day makes any difference is a question I cannot answer.
When I treated there was a reluctance to dose the way a non-transplant patient would have been dosed and that can be and, in my case, was problematic.
My history: liver transplant 1 year ago, had 2 moderate rejections and 1 mild since transplant. At present time having moderate rejection, recently had one portal stent and 8 Bilary ERCP's to remove stones and sludge and had stenting done, and at the present time there are no blockages. Was on Rapamune (5mg a day) prior to hernia surgery and then week before hernia surgery was put on Prograf (4mg a day) and taken off the Rapamune. I have been on Progaf since hernia surgery (8 weeks ago).
3 ISHAK). Initiating doses of ribavrin varied between 200 and 1200 mg/day (mean dose 600 mg). Dose reduction of ribavirin was needed in most patients and EPO support in 61%( n=17). The mean duration of treatment was 42 weeks. 53% (n=15) discontinued treatment prior to the anticipated end of treatment date, 66% (n=10) of these demonstrated inadequate virological response and 33% (n=5) discontinued because of significant adverse events on treatment.
More frequent aFib episodes, yet found to be hypertensive on 18-hour continuous BP study in neighborhood of 160/85 average when in sinus, lower BP when in Fib. Symptomatic in that exercise tolerance is significantly less when in Fib, also with constant chest "heaviness" and mild breathlessness.
Wish to control the arrhythmia which started ~ 6 mos ago and is now recurring once/week usually while asleep, and suspect that it is of parasympathetic character.
If i lower my prograf lower than 6.5 through rate i start getting discomfort right side .i am having cognitive issues on prograf that are getting very hard to live with, seems like it got alot worse after my last of three mri with contrast in two years. was hospitalized two days after last contrast exsposure white blood count went to1000, headach, fever urine got exstremly foamy, severe itching ,tighting and rashd eveloped on lower legs two weeks after.
I'm sorry to hear about your HE.
I've been on the alert for any information on this issue and I haven't seen a thing.
I visited your transplant clinic's site and if they're doing a trial they aren't saying a word about it.
From the little I know about it I would want more than 2 blood draws per week at least until the PI's effect on my Prograf plasma levels were clear.
some patients metabolize the prograf much more than others, especially after a partial liver transplant. It is still early after the transplant. as long as the liver tests are OK, he shouldn't worry. They should slowly push the dose of the prograf up, while he is taking the cellcept.
I believe that diarrhea can cause an elevation in Prograf level. Taking Prograf with food can decrease absorption and result in a lower Prograf level. This is even more pronounced if you take it with fatty food. If Prograf doesn't upset your stomach it is best taken about 1 hour before eating - on an empty stomach.
The range on my labs sheet is 4 - 16 so you are well within range.
t respond to prednisone or azathioprine, your doctor may prescribe stronger immunosuppressants, such as mycophenolate (CellCept), cyclosporine (Neoral, Sandimmune, others) or tacrolimus (Prograf).
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When medication fails to stop the progression of cirrhosis eventually a liver transplant must be considered. This is another reason to also seek treatment with a transplant facility.
Blood levels of tacrolimus (Prograf) can also be equally affected for the same reason as with cyclosporine. [both drugs are calcineurin inhibitors]
* omeprazole (Losec, Prilosec)
* oxycodone (Oxycodone is metabolized by the cytochrome P450 system, specifically CYP3A4, of which the bergamottin flavonoid is a strong inhibitor)
* hydrocodone (The hepatic cytochrome P450 enzyme CYP2D6 converts it into hydromorphone, a more potent opioid.
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