Switch from once-daily tacrolimus (Advagraf) to twice -daily Immediate-Release Tacrolimus (Prograf)) in liver transplantation: About a case report

Tacroclimus is an immunosuppressive drug widely used for the prevention of rejection in organ transplants. It is marketed in two forms: Prograf administered twice a day and Advagraf which allows only one administration per day. Advagraf is often used in liver transplantation. Through this clinical case, we demonstrate the role of the therapeutic drug monitoring in dosage optimization during the switch tacrolimus from the Advagraf form to the Prograf form. This is a 60-year-old patient who underwent liver transplantation in 2014 treated with Advagraf 2.5 mg once in the morning. The residual CO concentration was 7 ng / ml. Due to the unavailability of advagraf, this drug was switched to the prograf at the same dosage 2.5 mg / d in two doses (1.5 mg in the morning and 1 mg in the evening ). Co increased from 7 to 11 ng / ml, AUC was 194 ng.h / ml [120-150]. When substitution of Advagraf with Prograf, C0 monitoring should be regular and close and dosage adjustments should be made to ensure that a similar systemic exposure is maintained.