Replies

  • I take mine at 9 and 9 (Prograf). I was wondering if anyone has reported a rash taking Prograf?

    I'm new to the forum and just feeling my way around.

    Thanks

    Skyhawk

    • What kind of rash? I have been taking Prograf ever since my transplant more than eight years ago. I have developed trouble with tinea versicolor which causes discolored patches of skin. I can get it under control with a antifungal cream, but then it has come back. Luckily, I do not think it is serious, affecting appearance mostly. I hope that you can get the help you need regarding your rash. Best of wishes.

  • Hi Mark and Cisco, because of your, and other excellent comments I received on my unusual timing with the taking of my immunosuppressants (you can see my actual timing in another of my attached messages) I looked up the half lives of some of the meds I use. Half life is the amount of time it takes your body to reduce the dose you took until there is only 50% of that dose left in your body. Here are the half lives:

    Cellcept: 16.6 to 17.9 hrs
    Prograf: 15.6 hrs
    Everolimus: 28.0 hrs
    Prednisone: 18 to 36 hrs

    So, if you take 750mg Cellcept at 8am, you will still have more than 325mgs when you take your next dose at about 8pm. If you have a good math buddy, they could tell you what your stable max-min amounts would be in your blood stream and the rather small deviation in each med you would experience by taking your drug 1 to 2 hrs early or late. Bottom line is take your meds on time but you have a rather large buffer if for some reason you forget to take them exactly on time - so don't get nervous, it's ok to be late/early occasionally.
    • Bill, a couple of observations on your conclusions. The half-lives of these drugs are expressed by the manufacturers in ranges. Prograf (tacrolimus) for example has a half-life of 8 - 24h. It is incorrect to assume that the mean value (15.6h) is reliable for any particular individual. Many variables can be present that will influence the blood absorption rate, and thus the point at which the serum level becomes toxic. In the case of Cellcept, the manufacturer specifies  "MPA undergoes substantial enterohepatic circulation, contributing to its gastrointestinal toxicity. MPAG is converted by mucosal enzymes and gut flora to MPA and is reabsorbed. This results in secondary peaks in pharmacokinetic studies after 6 to 12 and 24 h". Essentially, this means an additional (secondary) absorption cycle is present in Cellcept doses which complicates any standard dosing formula.

      I would recommend that anyone considering the adoption of your theory be very, very cautious. When perfectly dosed and monitored, these drugs carry risk of  damage to internal organs. When the doses are administered haphazardly, the risks increase exponentially. Please check with your pharmacist or prescribing physician before deviating from dosing instructions. Good luck my friend.

  • I take Prograf and Cellcept at 9am and 9pm.

  • 11am and 11pm. I moved from the 6am and 6pm hospital schedule one hour at a time over 7 days. I am a night owl and late sleeper so this works perfectly. I agee that it should be a 12 hour interval pretty consistently to maintain even blood levels. Liver and kidney Feb 2012. Labs are all good.
  • My doc said to take them at about 12 hr intervals but said it wasn't critical as the meds maintain an effective level beyond 12 hrs. So I take my morning pills with breakfast which is 8am on Wed and between 9:30 and 10:30am other days. I take my evening pills after dinner around 9 to 10:15pm except on the evening before a blood test when I take them between 9 and 9:15pm or 12 hrs before the blood draw. I'm at 31 months post kidney transplant with all blood results stable and satisfactory except for a creatinine level of 1.6 to 2.0 (which appears to be normal for the kidney I received). I switched from Prograf to Everolimus about 2 months ago and my fatigue has thankfully disappeared. My doctors say to try to take your meds at 12 hr intervals but don't become anxious or worried about being exactly on time.
    • Bill, I agree with Cisco. At peak levels in the blood, these immunosuppressants can approach toxicity. If you take one dose 15 hours from the last, you are likely to take the next one 9 hours later to get back on the 12/12 schedule. This could cause the drug to exceed the peak level established for the dosage, thus placing a toxic load on your system for a few hours. Our bodies are probably able to handle the occasional out of sync nature of a late dose but several times a weeks on a regular basis could be detrimental to your health. Be careful.

      • Thanks guys for your replies. I'm sorry if I led you to think I do this every day, but I checked my records and can say that over the past 32 days I have taken my meds as follows:
        8-9 hrs, 1 time
        9-10 hrs, 5 times
        10-11 hrs, 8 times
        11-12 hrs, 13 times
        12-13 hrs, 25 times
        13-14 hrs, 6 times
        14-15 hrs, 6 times
        With the shortest time being 8:35 and the longest 14:25.

        I too would be very obsessive about taking my meds exactly on time and with or without food, etc., were it not for the specific input I received from my transplant team and my local nephrologist. I constantly keep them aware of what I'm doing, and as a result of your info (which I highly regard) I will again send an e-mail to them to make sure they are still aware of my odd schedules. However, these drugs will not reach anywhere near toxic levels because, as you know, we all (at least I did) started out taking 33.3% more of Cellcept, ~300% more Prograf and 1100% more Prednisone. I will let you know of the replies from my transplant team doctors and my local nephrologist, who I've been seeing for over 9 yrs. This is strictly for KIDNEY Transplants and as I note below for those who have easy access to medical care. My transplant team says if I continue to do well, my Prednisone will be reduced to 2.5mg at my 3 yr anniv in Feb 2014. I have now switched from Prograf to Zortress and still use the same dosing unschedule. Thanks again, I enjoy all the info and support that I receive from all members. Sorry for my late reply, I only saw it today. Incidentally, I just had a slight case of pneumonia and the ER Blood test cheered me up - my creatinine was an all time low 1.5. They pumped me up with antifreeze and sent me on my way as I felt fine.

        In addition, after reflection, you are both correct for the vast majority of transplant patients as they do not have the access to medical care that we have in the San Jose, CA, area. My nephrologist is 15 mis, my ER and hospital is 6 1/2 mis away, my drugs are available at both locations and at the hospital 24 hrs/day. If I lived where health care was harder to come by, I might try to be a little more vigilant in my med taking.

        Good luck to you and thanks for your many valuable inputs!
        • To answer the question, I went and listed the times when I actually took my meds. My schedule for the past 32 days is as follows:
          During this time I took my meds in the AM and PM as follows:
          AM. /PM.
          8-8:30, 5 times. /8-8:30, 2 times
          8:30-9, 6 times. /8:30-9, 6 times
          9-9:30, 6 times. /9-9:30, 4 times
          9:30-10, 3 times. /9:30-10, 3 times
          10-10:30, 7 times. /10-10:30, 10 times
          10:30-11, 4 times. /10:30-11, 5 times
          11-11:30, 0 times. /11-11:30, 2 times
          11:30-12, 1 times. /11:30-12, 0 times
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