International Journal of Clinical Pharmacy

, Volume 39, Issue 6, pp 1298–1303 | Cite as

Trough level from twice daily to once daily tacrolimus in early conversion kidney transplant recipients: a prospective study

  • Sayamon Sukkha
  • Busba Chindavijak
  • Preecha Montakantikul
  • Atiporn Ingsathit
  • Wichit NosoongnoenEmail author
  • Vasant Sumethkul
Research Article


Background Early conversion from twice-daily tacrolimus (TAC-BID) to once-daily tacrolimus (TAC-OD) provides a greater benefit of reducing under-exposure of TAC-OD during the first period after transplantation. Information regarding the conversion dose among Asian kidney transplant recipients is still limited. Objective This study aimed to compare the trough levels (Cmin) of TAC-BID (Prograf®) and TAC-OD (Advagraf®). The values were obtained from early conversion intervention by 1:1 milligram per-milligram. Setting A university-based hospital. Method This study employed a single-center, open-label, prospective and single-armed design. Fifteen de novo standard risk kidney transplant recipients were enrolled. Fourteen days after transplantation, the Cmin of TAC-BID (pre-conversion Cmin) was determined. Subsequently, TAC-BID was converted to TAC-OD with a similar dose. The Cmin of TAC-OD was first measured at a steady state (immediate post-conversion Cmin) and compared. All enrolled patients received therapeutic monitoring at the first and second months. Main outcome measure Pre-conversion Cmin of TAC-BID and immediate post-conversion Cmin of TAC-OD. Results The immediate post-conversion Cmin was found to be 23% lowered than the pre-conversion Cmin. However, the Cmin of TAC-OD was found to be similar to the pre-conversion Cmin compared during the follow-up period. Renal function was found to be stable in all patients over 2 months. Conclusion Early conversion therapy was associated with a significantly lower immediate post-conversion Cmin but comparable Cmin throughout the follow-up period. The “one to one conversion ratio” from TAC-BID to TAC-OD could be performed among Asian de novo kidney transplant recipients at an early period after transplantation.


Early conversion Formulation Kidney transplant Tacrolimus Trough level 



The authors would like to thank Supatat Chumnumwat, PharmD, BCPS, for his assistance in drafting the manuscript. Special thanks go to Stephen Pinder and Thomas McManamon for English editing. We also wish to thank Pitchaya Dilokpattanamongkol, BCPS, BCCP, for her helpful suggestion.


This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Conflicts of interest

The authors have no conflicts of interest to declare.


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Sayamon Sukkha
    • 1
  • Busba Chindavijak
    • 1
  • Preecha Montakantikul
    • 1
  • Atiporn Ingsathit
    • 2
  • Wichit Nosoongnoen
    • 1
    Email author
  • Vasant Sumethkul
    • 2
  1. 1.Division of Clinical Pharmacy, Department of Pharmacy, Faculty of PharmacyMahidol UniversityBangkokThailand
  2. 2.Department of Medicine, Faculty of Medicine, Ramathibodi HospitalMahidol UniversityBangkokThailand

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