Tacrolimus Drip

[freedom22]

I had to start a tacrolimus drip yesterday for suspected kidney rejection. Never had to before.

Just wondering what you would monitor for when a pt is on a tacrolimus drip? BP? HR?....

Also, do you obtain a tacrolimus level before starting the drip? And how often do you draw levels while the pt is on the drip???

Thanks for your responses!

[RNperdiem, RN]

I work with transplant patients and have never had to hang a tacrolimus drip either. I am curious to hear any answers too.

If I was in your position, a check of the my hospital drug formulary is where I would start, and if that is not helpful, call the pharmacist.

[blondy2061h, MSN, RN]

We use tacrolimus drips somewhat regularly. We don't do any specific monitoring in terms of vital signs. I can't think of how it effects any vital signs specifically. I really don't think it does. We draw tacro levels twice a week. It's important, if you're drawing them off a central line, to draw off a separate lumen than the tacro has EVER run in. Have a deticated tacro lumen. Tacro sticks to the tubing and you'll have a falsely high FK506. On our adult patients this has been such an issue that they have started drawing them peripherally only.

When I worked in kidney transplant, we drew tacro levels everyday inpatient.

[freedom22]

Thanks for your response. Good to know about the tubing!

Just wondering- why do you do tacro drips as opposed to PO tacro? Is it more effective? Faster onset?....

Thanks again.

[blondy2061h, MSN, RN]

Depends on what protocol the patient is on. Almost all of our patients start on IV tacro and move to PO tacro. Some of our patients start on PO and then end up vented or NPO due to GVHD and get moved to IV. Some get GVHD and are on IV for higher effectiveness. Some get the drip just to maintain blood levels studily. It really varies, but I'd say 99% of our patients are on IV tacro at some point.

[brissygal, BSN, RN]

Can I ask some question here too please?

Blondy2061h - when you refer to GVHD - I assume you are talking about graft versus host disease - would that be correct? I know we use Tacro in Oncology in Australia.

Sometime your terminology is different and confuses me.

Thanks very much.

Kind regards

[Nurseboy1]

brissygal: GVHD=graft vs host disease

I am taking care of a patient right now on a tacrolimus drip. I often see patients from the bone marrow transplant unit on tac. drips, I believe that due to the frequency of mucositis as well as N/V in that population that there are concerns with absorption. Therefore they seem to get their Tac. IV to ensure consistent blood levels.

[blondy2061h, MSN, RN]

Yes, I was referring to graft versus host disease. If they get it in their gut or upper GI tract they'll often be NPO until it resolves. If they get it anywhere, they may be on it for better absorption.

[blondy2061h, MSN, RN]

Also, it can lower mag levels. We test mag levels every day and give them IV mag as needed.

[brissygal, BSN, RN]

Thank you NurseBoy1 and Blondy2061h for clarification.

Interesting point on magnesium levels and Tacro.