Administration advice :
-Tacrolimus should not be used simultaneously with cyclosporine. Tacrolimus may be initiated at least 24 hours after stopping cyclosporine; however, dosing should be delayed if cyclosporine blood levels are elevated.
-Dosing should be titrated based on clinical assessments of rejection and tolerability, and to maintain recommended trough concentration ranges.
-Patients should not eat grapefruit or drink grapefruit juice with this drug.
Extended release :
-Should be taken once daily in the morning, preferably on an empty stomach at least 1 hour before or 2 hours after a meal; do not take with an alcoholic beverage; do not chew, divide, or crush.
-Take a missed dose as soon as possible but not more than 14 hours after the scheduled time. Beyond the 14-hour timeframe, the patient should wait until the usual scheduled time the following morning to take the next scheduled dose. Do not take 2 doses at the same time.
Reconstitution/preparation techniques: The manufacturer product information should be consulted.
-Frequent monitoring of tacrolimus whole blood trough concentrations is recommended; the manufacturer product information should be consulted.
-Whole blood trough concentrations usually range from 5 to 20 ng/mL. Extra caution and closer monitoring are recommended when graft function changes or drug interactions are suspected.
-Monitoring of cyclosporine blood concentrations should be continued post-conversion as tacrolimus may affect the clearance of cyclosporine.
-Renal and liver function and tissue biopsies should be monitored regularly.
-Blood glucose and serum potassium should be monitored.
-Consider obtaining electrocardiograms and monitoring electrolytes periodically in patients at increased risk for QT prolongation.
Patient advice: Since this drug may cause visual and/or neurological disturbances, patients should be cautioned against driving or operating machinery if they are affected.
Selective serotonin reuptake inhibitors (SSRIs) transfer into breast milk to varying extents. Paroxetine is reported to have the lowest transfer into breast milk (weight-adjusted infant dose 1-3%). Fluoxetine transfers to a greater extent (weight-adjusted infant dose ≤ 14%) and its active metabolite, norfluoxetine, has a long half-life of one to two weeks and may accumulate in a breastfed infant. Data on citalopram (weight-adjusted infant dose approximately 5%) suggest that the relative infant dose of citalopram is intermediate between paroxetine and fluoxetine. Based on these data, paroxetine is the preferred SSRI in breastfeeding women.