Drug Levels

Drug levels can be quite confusing because they are dependent on the patients disease status and the time since transplantation. However, there are certain ranges that we aim for.

Cyclosporine (Neoral)	0-6 months 1200-1600 6-12 months 1000-1200 12-18 months 800-1000 > 18 months 600-800	peak level
Tacrolimus (FK-506)	0-3 months 12-15 3-12 months 10-12 12-18 months 5-10 >18 months 5
Sirolimus (Rapamune)	5-10 If patient on Rapamune for renal sparing run FK 3-5 If patient on Rapamune for chronic rejection run FK 5-8

Steroid Weaning Protocol

	Neoral	FK
In OR	5 mg/kg	5 mg/kg
Day 1	5 mg/kg/day Q6	5 mg/kg/day Q6
Day 2	4 mg/kg/day Q6	4 mg/kg/day Q6
Day 3	3 mg/kg/day Q6	3 mg/kg/day Q6
Day 4	2 mg/kg/day Q6	2 mg/kg/day Q6
Day 5	1 mg/kg/day Q12	1 mg/kg/day Q12
Day 14		0.8 mg/kg/day
Day 30	0.8 mg/kg/day	0.5 mg/kg/day
Day 60	0.5 mg/kg/day	0.25 mg/kg/day
Day 90	0.25 mg/kg/day	0.25 mg/kg QOD
Day 120	0.25 mg/kg QOD	off
Day 180	off

Steroid Treatment for Acute Rejection

Day 1-3	10 mg/kg/day IV Solumedrol
Day 4	5 mg/kg/day IV Solumedrol
Day 5	4 mg/kg/day IV Solumedrol
Day 6	3 mg/kg/day IV Solumedrol
Day 7	2 mg/kg/day IV Solumedrol
Day 8	2 mg/kg/day PO Prednisone