Macé M. SCHUURMANS, Jérôme BONZON, René HAGE
Experimental and Clinical Transplantation - 2026;24(3):289-292
In most clinical settings, the tacrolimus dosing regimen is determined by the clinical judgment of the physicians, often based on a telephone consultation after trough levels are reported by the laboratory. Based on our own experience and evaluations, determination of the appropriate subsequent tacrolimus dose, given the present trough concentration and the target therapeutic range, is subject to considerable variability. Our study aimed to propose and implement a pragmatic decision aid for tacrolimus dose adjustments. We defined specific rules for tacrolimus dose adjustments and developed a table of standardized adjustment increments to facilitate individualized dosing regimens, considering multiple variables, including prior trough levels, renal function and concomitant use of other medications, particularly itraconazole. We evaluated our institutional experience during a period of more than 1 year. The proposed rules and dose adjustment table have helped standardize tacrolimus dose adjustments reproducibly by a simple intervention. The rule-based tacrolimus dose adjustment table and accompanying clinical rules still require validation studies.
