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Lansoprazole and omeprazole, as CYP2C19 and CYP3A4 substrates, may potentially inhibit the CYP3A4 metabolism of tacrolimus and thereby substantially increase tacrolimus whole blood concentrations, especially in transplant patients who are intermediate or poor CYP2C19 metabolizers, as compared to those patients who are efficient CYP2C19 metabolizers.
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To evaluate the efficacy and safety of early steroid withdrawal or steroid avoidance in the tacrolimus (Tac)-based immunosuppressive regimen for liver transplant recipients.
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Monitoring of blood concentrations and appropriate dosage adjustments of Tacrolimus are recommended when these drugs and Tacrolimus are used concomitantly.
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The use of sirolimus, mycophenolate mofetil, and anti-CD25 antibodies has been studied to determine whether graft survival and acute rejection rates can be maintained at the present rates in the absence of a calcineurin inhibitor.
In patients unable to take oral tacrolimus capsules, therapy may be initiated with tacrolimus injection.