Nephrology

441 Transplant Patient Medication Reference Guide

  • Transplant Medication Reference Guide Overview

    Transplant medications

    Initial

    1-2 months

    2-3 months

    3-6 months

    6 months

    Tacrolimus (Prograf)  Oral: 0.15-0.3mg/kg/d (as a divided dose) 

    Alter dose according to trough level  

    Alter dose according to trough level Alter dose according to trough level 

    Alter dose according to trough level

    Dose may vary if if rejection,polyomavirus or renal impairment is present

     Not to be given with Cyclosporin A

    IV: 0.05-0.06/kg/d

    Target: 6-10

    Target: 5-9

    Target: 4-8

    Target: 3-7

    Mycophenolate Mofetil (Cellcept)

    400mg/m2 BD (up to 1000mg BD max)

    400mg/m2 BD (up to 1000mg BD max)

    400mg/m2 BD (up to 1000mg BD max)

    400mg/m2 BD (up to 1000mg BD max)

    400mg/m2 BD (up to 1000mg BD max)

    Dose may vary if if rejection,polyomavirus or renal impairment is present

    (600mg/m2 if given with CyA)

    (600mg/m2 if given with CyA)

    (600mg/m2 if given with CyA)

    (600mg/m2 if given with CyA)

    (600mg/m2 if given with CyA)

    Prednisolone (Predmix/Solone)

    Dose may vary if if rejection,polyomavirus or renal impairment is present

    <20kg:

    15mg daily

    (wean to 10mg @ 1mth)

    <20kg: 

    10mg daily

    <20kg: 

    7.5mg daily

    <20kg: 

    5mg daily

    <20kg:  Wean by 1mg/month and cease if rejection - free

     

    >20kg:

    20mg daily

     

    >20kg:

    10/m2 mg daily

    >20kg:

     7.5mg daily

    >20 kg:

    5 mg daily

    > 20kg

    Wean by 1mg/month and cease if rejection - free

    Ranitidine (Zantac)

    Dose may vary if if rejection,polyomavirus or renal impairment is present

    Infants/children

    Oral:
    2-4mg/kg/dose

    8-12 hrly

    Infants/children   

    Oral:
    2-4mg/kg/dose

    8-12 hrly

    Infants/children 

    Oral:
    2-4mg/kg/dose

    8-12 hrly

       
     

    Adults
    Oral : 150mg BD

    Adults
    Oral : 150mg BD

    Adults
    Oral : 150mg BD

       

    Nystatin (Nilstat)

    Oral: 1-5ml QID Oral: 1-5ml QID Oral: 1-5ml QID    

    Trimethoprim-sulphamethoxazole(Bactrim)

    Dose may vary if if rejection,polyomavirus or renal impairment is present

    Prophylaxis: 2.5mg/kg daily until stent removed

    Prophylaxis:
    5mg/kg 3 x week (Mon, Wed, Fri)
    Prophylaxis:
    5mg/kg 3x week consecutive days eg: Mon, Tues, Wed
    Prophylaxis:
    5mg/kg 3x week
    consecutive days eg: Mon, Tues, Wed
    Prophylaxis:
    5mg/kg 3x week
    consecutive days eg: Mon, Tues, Wed

    Valganciclovir (Valcyte)

    See  Section 4.4.6 for dosing guidelines

    CMV +ve donor to CMV +ve recipient

    CMV -ve donor to CMV +ve recipient

    Dose may vary if if rejection,polyomavirus or renal impairment is present

    Day 10 post-op - 3 months

    >50kg:7x BSA x GFR (Schwartz)

     

    >50kg: 450mg-900mg daily

    Section 4.4.6 for dosing guidelines

     

    >50kg:7x BSA x GFR (Schwartz)

    >50kg: 450mg-900mg daily

    Section 4.4.6 for dosing guidelines

     

     

     

    >50kg:7x BSA x GFR (Schwartz)

    > 50kg:450mg-900mg daily

    Section 4.4.6 for dosing guidelines

       

    CMV +ve donor to CMV -ve recipient

    Dose may vary if if rejection,polyomavirus or renal impairment is present

    Day 10 post -op to 6 months

    >50kg:7x BSA x GFR (Schwartz)

     

    >50kg: 450mg-900mg daily

    Section 4.4.6 for dosing guidelines

     

    >50kg:7x BSA x GFR (Schwartz)

    >50kg: 450mg-900mg daily

    Section 4.4.6 for dosing guidelines

     

    >50kg:7x BSA x GFR (Schwartz)

    >50kg: 450mg-900mg daily

    Section 4.4.6 for dosing guidelines

     

    >50kg:7x BSA x GFR (Schwartz)

    >50kg: 450mg-900mg daily

    Section 4.4.6 for dosing guidelines

     

    >50kg:7x BSA x GFR (Schwartz)

    >50kg: 450mg-900mg daily

    Section 4.4.6 for dosing guidelines

    Sirolimus (Rapamune)

    Conversion from Tacrolimus or
    Cyclosporin @ 2-4 months

    Dose may vary if if rejection,polyomavirus or renal impairment is present

       

    Loading dose: 3mg/m2 daily

    Maintenance: 1mg/m2daily

    1mg/m2 daily maximum daily dose 4mg

    Adjust according to blood trough levels

    1mg/m2 daily maximum daily dose 4mg

    Adjust according to blood trough levels

     

     

     

    Give loading dose the day after CNI ceased then continue with maintenance dose

    Aim: 4-12 µg/ml

    Aim: 4-12 µg/ml

    Cyclosporin A(Neoral)

    Oral: 8-10mg/kg/d

           

    Dose may vary if if rejection,polyomavirus or renal impairment is present

    Aim for 2hr post dose level of 1600µg/L in first month

    Aim for level of 1000µg/L Aim for level of 1000µg/L Aim for level of 1000µg/L  

    Mycophenolate Sodium (Myfortic)

    Dose may vary if if rejection,polyomavirus or renal impairment is present

    300mg/m2 BD up to 720mg BD

    200mg/m2 BD if given with CyA

    300mg/m2 BD up to 720mg BD

    200mg/m2 BD if given with CyA

    300mg/m2 BD up to 720mg BD

    200mg/m2 BD if given with CyA

    300mg/m2 BD up to 720mg BD

    200mg/m2 BD if given with CyA

     

    Cefazolin                       IV 15mg/kg at induction,

                                        then 6hrly for 48 hours