31DEC

Welcome To MJPPS

The editors welcome the submission of relevant articles for editorial consideration. Manuscripts should be addressed to editor@medjpps.com.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences
https://app.periodikos.com.br/journal/medjpps/article/doi/10.5281/zenodo.17916338

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Commentary

Switch from once-daily tacrolimus (Advagraf) to twice-daily immediate-release tacrolimus (Prograf) in liver transplantation: Case study

Habiba Fetati, Fatima Boudia, Fatima Z. Kouaidia, Nadjer FZ Mekaouchen, Asmaa Memou, Nihed Amara, Houari Toumi

Downloads: 0
Views: 131

Abstract

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 therapeutic drug monitoring in dosage optimization during the switch to 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 7.0 ng/ml. Due to the unavailability of Advagraf, this drug was switched to Prograf at the same dosage, 2.5 mg/d in two doses (1.5 mg in the morning and 1.0 mg in the evening). Co increased from 7.0 to 11.0 ng/ml, AUC was 194 ng.h/ml [120-150]. When substituting Advagraf for Prograf, C0 monitoring should be regular and close, and dosage adjustments should be made to ensure that a similar systemic exposure is maintained.

Keywords

Pharmacokinetic, tacrolimus, therapy individualizing, therapeutic drug monitoring

References

  1. Tasdogan BE, Ma M, Simsek C, Saberi B, Gurakar A. Update on immunosuppression in liver transplantation. Euroasian Journal of Hepato-Gastroenterology. 2019; 9(2): 96-101. doi: 10.5005/jp-journals-10018-1301
  2. Ma TK-W, Chow KM, Cheng PM-S, Kwan BC-H, Leung CB, Li PK, Szeto CC. Pharmacokinetic study of once-daily formulation of tacrolimus (Advagraf) in stable Chinese kidney transplant recipients. Hong Kong Journal of Nephrology. 2016; 19: 1-6. doi: 10.1016/j.hkjn.2016.03.002
  3. Clinical Guidelines For Transplant Medications 2019. CMV guideline update (cardiac) AMB.03.007 Rev11 Eff
  4. Brunet M, van Gelder T, Åsberg A, Haufroid V, Hesselink DA, Langman L, et al. Therapeutic drug monitoring of tacrolimus-personalized therapy: Second consensus report. Therapeutic Drug Monitoring. 2019; 41(3): 261-307. doi: 10.1097/FTD.0000000000000640
  5. Beckebaum S, Iacob S, Sweid D, Sotiropoulos GC, Saner F, Kaiser G, Radtke A, Klein CG, Erim Y, de Geest S, Paul A, Gerken G, Cicinnati VR. Efficacy, safety, and immunosuppressant adherence in stable liver transplant patients converted from a twice-daily tacrolimus-based regimen to once-daily tacrolimus extended-release formulation. Transplant International. 2011; 24(7): 666-675. doi: 10.1111/j.1432-2277.2011.01254.x
  6. Okumura Y, Noda T, Eguchi H, Iwagami Y, Yamada D, Asaoka T, et al. Short- and long-term outcomes of De Novo liver transplant patients treated with once-daily prolonged-release tacrolimus. Transplantation Direct. 2017; 3(9): e207. doi: 10.1097/TXD.0000000000000722.
  7. Alloway R, Steinberg S, Khalil K, Gourishankar S, Miller J, Norman D, et al. Conversion of stable kidney transplant recipients from a twice daily Prograf-based regimen to a once daily modified release tacrolimus-based regimen. Transplantation Proceedings. 2005; 37(2): 867-870. doi: 10.1016/j.transproceed.2004.12.222
  8. Florman S, Alloway R, Kalayoglu M, Lake K, Bak T, Klein A, et al. Conversion of stable liver transplant recipients from a twice-daily Prograf-based regimen to a once-daily modified release tacrolimus-based regimen. Transplantation Proceedings. 2005; 37(2): 1211-1213. doi: 10.1016/j.transproceed.2004.11.086
  9. Heffron TG, Pescovitz MD, Florman S, Kalayoglu M, Emre S, Smallwood G, et al. Once-daily tacrolimus extended-release formulation: 1-year post-conversion in stable pediatric liver transplant recipients. American Journal of Transplantation. 2007; 7(6): 1609-1615. doi: 10.1111/j.1600-6143.2007.01803.x
  10. Moini M, Schilsky ML, Tichy EM. Review on immunosuppression in liver transplantation. World Journal of Hepatology. 2015; 7(10): 1355-1368. doi: 10.4254/wjh.v7.i10.1355
  11. Trana Hussaini, Siegfried Erb, Eric M. Yoshida. Immunosuppressive pharmacotherapy in liver transplantation. AME Medical Journal. 2018; 3(1): 18. doi: 10.21037/amj.2018.01.07

Submitted date:
11/02/2025

Reviewed date:
12/08/2025

Accepted date:
12/11/2025

Publication date:
12/12/2025

693c7467a953954a8326f8b8 medjpps Articles
Links & Downloads

Mediterr J Pharm Pharm Sci

Share this page
Page Sections