NICE guidance Immunosuppressive therapy for adult renal transplantation and immunosuppressive therapy for renal transplantation in children and adolescents (April 2006)

1. Protocols for the monitoring of cytotoxic drugs prescribed by cancer specialists are available within the Trust.

2. CSM Warning: Cardiomyopathy has been reported in children given tacrolimus after transplantation. Patients using the drug should be monitored carefully by echocardiography for hypertrophic changes; dose reduction or discontinuation should be considered if these occur.

3. Because of differences in bioavailability the brand of oral ciclosporin should be specified by the prescriber.

4. MHRA Drug Safety Update (June 2012) The growing number of oral tacrolimus products available on the market increases the potential for inadvertent switching between products, which has been associated with reports of toxicity and graft rejection. Therefore, to ensure maintenance of therapeutic response when a patient is stabilised on a particular brand, oral tacrolimus products should be prescribed and dispensed by brand name only. If a prescriber considers that switching a patient to a different brand of oral tacrolimus would be of benefit, the change requires careful supervision and therapeutic monitoring by an appropriate specialist