Drugs-Maintenance Flashcards
Tacrolimus: FDA approved indications
IR: adult or ped kidney, liver & heart txp
XL: adult or ped kidney txp
XR: adult kidney txp
Tacrolimus: Dosage Forms
IR: - Capsules 0.5, 1, 5 mg - Granules for oral susp: 0.2 mg or 1 mg packets - 5 mg/mL injection XL: - Capsules 0.5, 1, 5 mg XR: - Tablets: 0.75, 1, 4, mg
Tacrolimus: starting dose per PI
IR: 0.075 - 0.2 mg/kg/day divided
XL: 0.15 - 0.2 mg/kg/day
XR: 0.14 mg/kg/day
Tacrolimus IR –> XR Conversion. PI? ASTCOFF? ASERTAA?
PI: 80% IR TDD –> XR dose
ASTCOFF: 70% IR TDD –> XR dose
ASERTAA: 80% IR TDD –> XR dose (note AA population; majority CYP3A5*1 expresser)
Tacrolimus: PI recommendations regarding food
IR: consistently with or without
XL: empty stomach
XR: empty stomach (1 hour before a meal or at least 2 hours after a meal)
CPIC Recommendations for FK Dosing in CYP3A5*1 Expressers
1.5 - 2x usual starting dose (max 0.3 mg/kg/day)
For both heterozygous or homozygous for *1 allele
Cyclosporine: FDA approved indications
Kidney, liver, and heart txp
Cyclosporine: Dosage Forms
Capsule: 25, 100 mg
Oral soln: 100 mg/mL
IV (Sandimmune): 50 mg/mL
Cyclosporine: starting dose per PI
7 - 9 mg/kg/day divided Q12
Mycophenolate: FDA approved indications
MMF: Kidney, heart, liver txp
MFT: adult and ped kidney txp in combo with CsA adn CS
Mycophenolate: Dosage Forms
MMF: 250 caps, 500 tabs, 200 mg/mL suspension, 500 mg single-dose vial for IV use
MFT: 180 mg, 360 mg tablets
Mycophenolate: recommended pediatric dosing per PI
MMF: 600 mg/m2 BID
MFT: 400 mg/m2 BID
BSA = sqrt(ht*wt/3600)
IV MMF: Administration
Duration: over at least 2 hours
Periph or central
Reconstitute with D5W
Start infusion within 4 hours of reconstitution
PI Recs for missed MMF dose:
Take ASAP unless next dose is <2 hours away
PI recs for how soon to give MMF post-txp
Within 24 hours of txp
PI recs for how soon to give FK post-txp
Liver/Heart: no sooner than 6 hours post-txp
Kidney: within 24 hours but should be delayed until renal fxn has recovered
PI Recs for missed FK dose:
IR: ???
XR: ASAP if within 15 hours of missed dose; if >15 hours, wait
MPA TDM: If you were to do it, what trough or AUC would be your goal?
AUC: 30-60
Trough:
- CsA >1.3
- FK >1.9 (>2-3 for thoracic; >1-3.5 for peds, bowel, panc, liver)
Which drugs need to be separated from MMF by at least 2 hours per PI?
- Antacids with Mg or AlOH
2. Ca-Free Phosphate binders
AZA: FDA approved indications
Kidney txp
AZA: Dosage Forms
Tabs: 50 mg (as imuran, scored tablets)
Tabs: 75 mg, 100 mg (as Azasan)
Injection: 100 mg vial
AZA: Dosing per PI
3-5 mg/kg/day initially then 1-3 mg/kg/day
CPIC: AZA Recommendations for Intermediate & Poor Metabolizers
TPMT; where lack of fxn = accumulation of TGN and myelotoxicity
Intermediate Metabolizer (1 no fxn allele): 30 - 80% normal starting dose
Poor Metabolizer: Avoid therapy or 10-fold reduction and dose 3x weekly
AZA: Dose reduction with XO inhibitors per PI
DDI = inc conc of toxic metabolites
Allopurinol: Reduce AZA to 1/3 to 1/4 the usual dose
Febuxostat: Not recommended
Sirolimus: FDA indication
13+ YO post-txp in setting of chronic CsA + CS for high-risk recipients OR CsA withdrawal after 2-4 months post-txp in low-risk