Tacrograf therapy requires close supervision by adequately trained and equipped personnel. The drug should be prescribed only after the initiation of changes in immunosuppressive therapy by physicians experienced in immunosuppressive therapy and management of transplant patients.
Accidental, unintentional, or uncontrolled switching of immediate or sustained release formulations of tacrolimus is not safe. This can lead to graft rejection or an increased incidence of side effects, including insufficient or excessive immunosuppression, due to clinically significant differences in systemic exposure to tacrolimus. Patients should be kept on the same formulation of tacrolimus with an appropriate daily dosing regimen; Changes in composition or regimen should only be made under the close supervision of a transplant specialist. After conversion to any alternative formulation, the therapeutic drug should be monitored and dosage adjusted to ensure that the systemic effects of tacrolimus are maintained.
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