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Is Tacrolimus Level Of 27.5 A Cause For Concern?

Posted on Thu, 7 Jan 2016

Question: What does a 27.5 tech level signify in a kidney transplant patient , could pantociid kit Hp increase the tacrolimus levels

Answered by Dr. Rakesh Madhyastha (23 minutes later)

Brief Answer:
Very high tacrolimus level

Detailed Answer:
Hello

Thanks for the query

From the history you have given it is difficult for me to interpret the TACROLIMUS level. We try to maintain Tacrolimus level between 8 to 10 in the first 6 months of transplant.

Various reasons can rise the Tacrolimus level but before that I need to know the following

1. Did you give your blood for testing after taking the tablet or before ?
2. How much milligram of tacrolimus are you taking per day ?
3. Are you taking any tablet like dilzem-SR ?
4. Please mention the contents of the HP-kit so that I can run an interaction check with Tacrolimus
5. Any history of loose stools? loose stools and dehydration can increase Tacrolimus

Awaiting your reply

Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Rakesh Madhyastha (57 minutes later)

Dear Doctor

1. The blood was given for testing before medication a month ago my tachrolimius level was 7

2 . The new medicines added in last one month are
Pantoacid HP kit whose content is. pantoprazole 40 mg, amoxicillin 750 mg, clarithromycin 500 mg.dosage twice a day

Nexpro 40 mg
A02BD04 - pantoprazole, amoxicillin and clarithromycin; Once a day

Urivoid
Dytor 5mg

There is no history of loose stools

Other medicines I am

Other medicines I am taking are
Pangraf1.5mg twice a day
Myfrotic(360x2) twice a day
Omnacartis 15 mg once a day
SepmaxDS once a day
Rosuvas10mg once a day
Carca6.25 twice a day
Arkamin 0.1 mg twice a day
Cintropo1mg thrice a day
Vobit m 0.3 mg twice a day
Metsmail 1000 mg once a day
Insultard injection 52units
Apidra 40 units
Ciplox250mg twice a day
Urivoid 25 mg twice a day
Tragenta 5mg once a day
Dytor 5mg

Answered by Dr. Rakesh Madhyastha (25 minutes later)

Brief Answer:
Clarithromycin increases tacrolimus levels

Detailed Answer:
Hello

Thanks for the query

Clarithromycin in known to increase tacrolimus level further more amox is known to decrease tac levels.
In such a situation we repeat tacrolimus every 4th day to stabilise to the required levels. Please speak to your nephrologist for dose adjustment as soon as possible. High tac level is known to be nephrotoxic.

I also recommend you to repeat the tacrolimus level as there are chances that it might be a false reading. Some of the symptoms and signs of tac toxicity are

1. Increasing serum creatinine which was otherwise stable
2. Tremors of the hands

I hope I was of help, if you have any further queries please get back to me

Regards

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Rakesh Madhyastha (27 minutes later)

My serum creatinine is 0.93 and and GFR 0.84

I have none of the above symptoms suggested by you

Answered by Dr. Rakesh Madhyastha (11 hours later)

Brief Answer:
Re check Tac level

Detailed Answer:
Hello

If you do not have any of the above symptoms and your creat has not increased then I recommend you to re check your tac level

Regards

Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Yogesh D