TACROCIN 1- TACROLIMUS CAPSULE USP 1 MG

ACCORD HEALTHCARE PRIVATE LIMITED

ACCORD HEALTHCARE PRIVATE LIMITED

Therapeutic

Prescription Only

CAPSULE, GELATIN COATED

**4.2 Posology and method of administration** Only physicians experienced in immunosuppressive therapy and the management of organ transplant patients should prescribe Tacrolimus. Patients receiving the drug should be managed in facilities equipped and staffed with adequate laboratory and supportive medical resources. The physician responsible for maintenance therapy should have complete information requisite for the follow-up of the patient. The dosage recommendations given below are intended to act as a guideline. Tacrolimus doses should be adjusted according to individual patient requirements. **Dosage recommendations** **Primary Immunosuppression Dose Levels – Adults** Liver and kidney transplantation: Oral tacrolimus therapy should commence at 0.10 – 0.20 mg/kg/day for liver transplantation and at 0.15 – 0.30 mg/kg/day for kidney transplantation administered as two divided doses. Administration should start approximately 6 hours after the completion of liver transplant surgery and within 24 hours after completion of kidney transplant surgery. **Primary Immunosuppression Dose Levels – Paediatric Patients** Paediatric patients generally require doses 1.5 to 2 times higher than the recommended adult doses to achieve the same blood levels. **Liver and kidney transplantation:** An initial dose of 0.3 mg/kg/day for liver and kidney transplantation should be administered in two divided doses. **Maintenance Therapy Dose Levels** It is necessary to continue immunosuppression with oral Tacrolimus to maintain graft survival. Dose can frequently be reduced during maintenance therapy. Dosing should be primarily based on clinical assessments of rejection and tolerability of the patient. If progression of disease occurs (e.g. signs of acute rejection) alteration of the immunosuppressive regimen should be considered. Increase the amount of corticosteroids, introduction of short courses of mono/polyclonal antibodies and increase in the dose of Tacrolimus have been used to manage rejection episodes. If signs of toxicity (e.g. pronounced adverse event) are noted, the dose of Tacrolimus should be reduced. When Tacrolimus is administered in combination with a corticosteroid these may often be reduced and in rare cases the treatment has continued as monotherapy. **Therapy Dose Levels for Liver and Kidney Allograft Rejection Resistant to Conventional Immunosuppressive Regimens** In patients experiencing rejections episodes which are unresponsive to conventional immunosuppressive therapy, Tacrolimus treatment should begin with the initial dose recommended for primary immunosuppression in that particular allograft. Tacrolimus should be initiated after considering cyclosporin blood concentrations and the clinical condition of the patient. In practice, Tacrolimus therapy has been initiated 12–24 hours after discontinuation of cyclosporin. Monitoring of cyclosporin blood levels should be continued following conversion as the clearance of cyclosporin may be affected. **Duration of dosing** For oral dosing the capsules normally have to be taken continuously to suppress graft rejection and no limit for therapy duration can be given. **Mode of Intake** Capsules should generally be administered on an empty stomach or at least 1 hour before or 2 to 3 hours after a meal, to achieve maximal absorption (See Pharmacokinetic properties – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). **Monitoring of Whole Blood Concentrations** Drug level monitoring is recommended during the early post-transplantation period, following dose adjustment of Tacrolimus therapy after switching from another immunosuppressive regimen or following co-administration of drugs which are likely to lead to a drug interaction. Trough blood levels of Tacrolimus should also be monitored periodically during maintenance therapy. The frequency of blood level monitoring should be based on clinical needs. As tacrolimus has a long half-life, it can take several days for adjustments in Tacrolimus dosing to be reflected in changes in blood levels. **Patient with Liver Impairment** A dose reduction is necessary. **Patient with Renal Impairment** Careful monitoring of renal function including serial creatinine estimations, calculations of creatinine clearance and monitoring urine output is recommended. **Elderly Patients** There is no evidence currently available to indicate that dosing should be adjusted in older people.