Therapeutic dosages of cyclosporine and tacrolimus
| Cyclosporine | Ref. | Tacrolimus | Ref. |
|---|---|---|---|
| Oral (Sandimmune and Neoral are not interchangeable) Sandimmune (Novartis) • 4 to 12 hours pre-transplant: 14 to 18 mg/kg by mouth for one dose • Initial single daily dose continued 1-2 weeks post-transplant • Reduce the dose by 5% per week to maintenance dose of 5 to 10 mg/kg per day by mouth divided twice per day. Neoral (Novartis) • 12 hours pre-transplant: 10 to 15 mg/kg in two divided doses by mouth (12 hours apart) • Initial dosage maintained for 1-2 weeks post-transplant • Reduce the maintenance dose by 2-6 mg/kg per day in two divided doses by mouth. IV (maximum concentration 2.5 mg/dL) • 4 to 12 hours pre-transplant IV: 5 to 6 mg/kg IV for one dose over 2 to 6 hours • Post-transplant until the patient can tolerate oral therapy: 3 to 5 mg/kg IV once per day. • Adjust dosage according to trough levels |
33,34 | Liver transplant: with corticosteroids only • Oral: IR: 0.1 to 0.15 mg/kg/day in two divided doses, every 12 hours ER: Extended release formulation is not FDA approved for liver transplantation due to increased mortality in female liver transplant patients. • IV: 0.01-0.05 mg/kg as a continuous infusion Heart transplant: use in combination with azathioprine or MMF • Oral: IR: 0.075 mg/kg/day in two divided doses, every 12 hours • IV: initially 0.01-0.02 mg/kg/day as a continuous infusion Lung transplant: use in combination with azathioprine or MMF • Oral: IR: 0.075 mg/kg/day in two divided doses, every 12 hours • IV: initial 0.3 mg twice daily (<50 kg) or 0.5 mg (>50 kg) twice daily as a continuous infusion Kidney transplant: use in combination with azathioprine or MMF • Oral: IR: initially, 0.2 mg/kg/day (with azathioprine) or 0.1 mg/kg/day (with mycophenolate mofetil) XL: 0.15 to 0.2 mg/kg/day with basiliximab induction; 0.2 mg/kg/day without basiliximab induction XR: initially 0.14 mg/kg/day (with antibody induction) • IV: 0.03 mg/kg/day as a continuous infusion |
35-37 31,38 31,39 31,32,40,41 |
(IV: intravenous, Ref.: reference, IR: immediate-release, ER: extended-release, FDA: U.S. Food and Drug Administration, MMF: mycophenolate mofetil, XL: extra-long, XR: extended-release)