In PICU: Daily mane 200-300 ng/mL level (and give) >12 months: 100-150 ng/mL Diltiazem used to improve pharmacokinetics Tacrolimus 0.1 mg/kg/dose 12 Liver: Nephrotoxicity hourly oral/NG. <3m post Hypertension titrated to keep 10-15g/L Hyperglycaemia target 12-hr trough 3-12m post Dyslipidaemia levels. 8-12g/L Hyperkalaemia In PICU: Daily >12m post Low Mg mane level (and 5-10g/L Neurotoxicity give) Heart: <6m post: 9-13ng/ml >6m post: 7-9ng/ml Cell cycle agents (Purine/Pyrimidine synthesis) Reduced B and T lymphocytes as well as monocytes in the blood Azathioprine 1.5 mg/kg/dose Dose alteration/ Cytopaenias nocte oral/NG withheld if Hepatitis (rare) cytopaenia or Pancreatitis pancreatitis Malignancy Mycophenolate IV or oral Dose alteration/ GI mofetil 600mg/m2/dose BD withheld if WCC<4 Leukopenia x109/L OR Neut <1x109/L IV and oral bioequivalence
In PICU: Daily mane level (and give) 200-300 ng/mL >12 months: 100-150 ng/mL Diltiazem used to improve pharmacokinetics Tacrolimus 0.1 mg/kg/dose 12 hourly oral/NG. titrated to keep target 12-hr trough levels. In PICU: Daily mane level (and give) Liver: <3m post 10-15g/L 3-12m post 8-12g/L >12m post 5-10g/L Heart: <6m post: 9-13ng/ml >6m post: 7-9ng/ml Nephrotoxicity Hypertension Hyperglycaemia Dyslipidaemia Hyperkalaemia Low Mg Neurotoxicity Cell cycle agents (Purine/Pyrimidine synthesis) Reduced B and T lymphocytes as well as monocytes in the blood Azathioprine 1.5 mg/kg/dose nocte oral/NG Dose alteration/ withheld if cytopaenia or pancreatitis Cytopaenias Hepatitis (rare) Pancreatitis Malignancy Mycophenolate mofetil IV or oral 600mg/m2/dose BD Dose alteration/ withheld if WCC<4 x109/L OR Neut <1x109/L IV and oral bioequivalence GI Leukopenia