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Ensuring that tacrolimus blood concentrations remained within a relatively narrow therapeutic range most of the time may also have been effective in reducing toxicity as seen by unchanged serum creatinine and bilirubin levels. stop or reduce H2 antagonists or proton pump inhibitorsStrategies for dose adjustments for patients with low serum concentrationsif using capsules, stop or reduce H2 antagonists or proton pump inhibitorsif using solution check it is being given in the fasting stateremove acid suppression if possible (i.e. It is active against the commonest medically important fungal pathogens, such as Itraconazole is used for the treatment of oral and oesophageal candidosis, prevention of fungal infections in patients with profound and prolonged neutropenia, and treatment of invasive aspergillosis and cryptococcosis in patients who are refractory or intolerant to other first-line antifungal agents.The extent of oral bioavailability of itraconazole is variable and dependent on the specific formulation. Although the desired target blood tacrolimus level ranges varied, the most commonly used range was 5–15 ng/ml.Maintaining blood tacrolimus concentrations within a narrow target range can be challenging in HSCT patients. You can also search for this author in Przepiorka D, Nash RA, Wingard JR, Zhu J, Maher RM, Fitzsimmons WE Wallemacq P, Goffinet JS, O’Morchoe S, Rosiere T, Maine GT, Labalette M Osowski CL, Dix SP, Lin LS, Mullins RE, Geller RB, Wingard JR . Most evidence supporting TDM is circumstantial. fluconazole, erythromycin) then your doctor may suggest another treatment or a different dose either of the tacrolimus or of your other medication. Fluconazole is a triazole antifungal that is active against most species of Candida ... (most importantly cyclosporine and tacrolimus) ... may be many times in excess of those levels found in the blood, 112 which may in future influence the recommendations for monitoring of blood levels … Mycology Reference Centre, University Hospital of South Manchester and Manchester Academic Health Science Centre Among these, the members of the triazole family of antifungal drugs (namely fluconazole, itraconazole and voriconazole) are routinely used around the HSCT period. Practical considerations in the use of tacrolimus for allogeneic marrow transplantation. For Permissions, please e-mail: journals.permissions@oup.com Subsequently, concentrations were generally monitored 2–3 times a week with dose adjustments as necessary. Clinicians frequently forget that therapeutic concentration ranges cited by reference laboratories are derived from populations of patients. However, the more serious liver toxicity and myelosuppression are generally only seen with prolonged maintenance of high blood levels.