Tacrolimus is an immunosuppressive medicine which has been used in kidney transplants with excellent results for a long time. It is 10 times more potent than Cyclosporin which is another similar medicine which has previously been used in difficult patients with Nephrotic syndrome both children and adults. It is used in kidney transplant,Nephrotic syndrome, SLE and other immunological diseases. My research paper, when I was a Professor at SGPGIMS, for the first time proved that this could be a new treatment for these difficult children with nephrotic syndrome. It has a response rate of 80% even n steroid resistant nephrotic syndrome. However it needs close monitoring by an experienced nephrologist.
Director of nephrology and kidney transplant photos of hospitals and director kidney clinic today i am going to tell you seven facts about tacrolimus first we will discuss what is tacho elements and second in which diseases is tachrolimus used third which medicines should be avoided by patients who are on techrolimus fourth why do we need to monitor tactile
Image levels fifth what are the side effects of tachometers sixth what are the ideal technologist levels seventh and most important how should you monitor tacrolimus levels and how what time to the blood sample should be taken so first of all we will start by what exactly is tacrolimus so tachylimus is a drug that belongs to a group of drugs called calcium
Urine inhibitors and it is one of the most powerful immunosuppressive medications that is why it is called a superdrug and ever since it has been discovered it’s been used in a wide variety of diseases second in which diseases is stagnolimus used so tachrolimus first was used in kidney transplant patients and it was found to be so good that currently about 95
To 99 percent patients all over the world are on acronyms as one of the essential drugs second i was one of the leading researchers to show that tachylomus is a powerful drug for nephrotic syndrome especially steroid resistant product syndrome which is very difficult to treat and this paper was published in nephrology dialysis transplantation this is one of the
Largest series third systemic lupus erythematosus is another immunological disease where acrolimus has been used especially in pregnant ladies where our the choice of drugs becomes very limited uh then it has also been used in a variety of other diseases like psoriasis but it’s in use is increasing and it’s a very good immunosuppressant drugs third this drug
Should be avoided in patients on tackle levels now there are certain drugs which are metabolized by the same pathway like acrylimus and there are some drugs which called increased acrylic levels so you have to be very cautious among this group of drugs is an antibiotic like azithromycin or clarithromycin so if you are taking it simultaneously then there is a
Drug called uh diltiazam if you are using these drugs like uh radiation which is used for blood pressure for heart diseases your decremental level go up then if you are using anti-convulsants um these drugs actually um lower the acronymous levels especially uh phenytoin and vaporic acid and carbamespine these drugs actually lower the uh technology levels then
Among the anti-tb drugs rifampicin is the drug that you should not be using or you have to be using it very cautiously along with acronyms because rotamerizing also reduces the technology levels and anti-fungal medications like flucorazole ketoconazole actually cause a dramatic increase in the technologist levels and from treatment point of view we have used two
Strategies deltaism has been used as well as anti-fungal medications like fluconazole and ketoconazole have been used to increase sacral levels levels in those patients where we are finding it difficult to maintain technologists adequate technologist levels fourth why do we need to monitor technology levels now technologist level is belongs to a group of drugs
Which have narrow therapeutic index what does this mean that there is a very narrow gap between this therapeutic level and the toxic level that therapeutic level is the minimum level you may need to maintain below which you know there will be no benefit of the drug and toxic level is the level below which you should maintain the drug level because otherwise the
Risk of side effects increases and the gap in tacrolimus is very small so there is a very high risk of side effects and that’s why we have to monitor the acronymous levels in all patients who are on this therapy fifth what are the side effects of technologists well there are some short-term side effects and there are some long-term side effects so we’ll first
Discuss what are the short-term side effects so tetheramus can cause shaking or tremors of the body techniques can increase your blood glucose levels across can cause high blood pressure or increase the requirement of blood pressure medications technologies can cause increase in the lipid levels your cholesterol levels will go up if you are on technology and it
Can also cause neurological side effects amongst which are neuropathy as well as press syndrome and we have reported these side effects in large number of patients among for the first time from our country and it is published in scientific literature over a long period of time if you continue tacrolimus technologies can also damage the kidney so it’s a nephrotoxic
Medication that’s why it should not go unsupervised and i have personally seen children with nephrotic syndrome where the liver level was not measured for a long time they ended up with kidney damage now nephrotic syndrome is a disease where which is a treatable disease which rarely causes kidney damage but unfortunately this was not done in by a person who was
Expert in monitoring these patients and that’s why they forgot to monitor technological levels so word of caution here if you are taking tactile muscles take it under the supervision of an expert who has been using this for a long time number six what are the ideal technologies levels what should you maintain and every time this question is asked by a lot of our
Patients and what i tell them is that it depends totally on the disease you are treating and the time after which the treatment has been going on so initially in all these diseases we tend to maintain high technology levels but even there we will not exceed 15 a level of more than 15 is definitely hazardous a level below 12 is desirable and as the time passes
To minimize the risk of side effects we start reducing the technologies dose to lower the technology levels for the kidney transplant patients the levels have been very clearly defined for the first three months after kidney transplant you should have levels somewhere between 8 to 12 for the next 3 months that is 3 to 6 months it should be 5 to 8 and beyond 6
Months it should be 3 to 5. now there is a word of caution here it is technically very complex thing to manage the equilibrius level it depends on the method they are using also so always talk to your doctor about what level has to be maintained because it depends on the method the time after which the disease you have been using how long have you been using
What are the other drugs that you are using seventh how should the blood sample being taken for measuring tacrolimus i think this is one of the most important because if you do not take it properly you get a wrong level and it will lead to uh wrong diagnosis sometimes the doctors even don’t know but a good doctor always asks at what point of time did you give the
Tacular sample so what we do is we measure the trough levels that means a level that is taken just before the morning dose and these two doses of acrylamide should be taken about 12 hours apart yes there are some preparations now available called long acting preparation sustained release preparation which can be taken once a day here again the sample should be
Taken just before the dose so trough levels is what we monitor so this was what a a summary of seven important facts about tacrolimus and all patients of techrolimus should be knowing this so that because knowledge is power and you should be discussing these upfront with your nephrologist there’s another video on technology the super drug in nephrotic syndrome
That is in hindi and there are other videos that we have put forward so if you like this video please subscribe to my channel the kidney clinic thank you
Transcribed from video
Tacrolimus 7 Facts :What ,Which, How, Why and When ? : DR Sanjeev Gulati By Dr Sanjeev Gulati Kidney ClinicliveBroadcastDetails{isLiveNowfalsestartTimestamp2021-06-26T163014+0000endTimestamp2021-06-26T164119+0000}