Initial dosing | CsA-based regimen: start MMF at 1.5 g twice daily, and then adjust dosage on the basis of TDM |
Tacrolimus-based regimen: start MMF at 1 g twice daily | |
Frequency of monitoring and dose adjustment | Days 3 and 7 and once during days 10 to 14 after transplantation |
Week 3 or 4 (optional) | |
Occasions of substantial changes in immunosuppressant regimen | |
Occasions that require evaluation of clinical events, such as drug-related toxicity or rejection | |
Assay considerations | Either HPLC or EMIT is acceptable for monitoring |
MPA target concentrations using EMIT are higher (as a result of cross-reactivity with AcMPAG) | |
Target concentrations (HPLC) | MPA AUC |
30 to 60 mg·h/L in the first 30 d after transplantation | |
MPA C0 | |
CsA-based regimen: ≥1.3 mg/L | |
tacrolimus-based regimen: ≥1.9 mg/L | |
Special populations | |
calcineurin inhibitor-sparing regimen | |
a higher end of MPA target concentrations range is required | |
altered protein binding: free drug MPA concentration can be higherb | |
renal impairment | |
high bilirubin | |
Dosage adjustmentc | ![]() |
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↵a Data are summary of reference (45). AcMPAG, MPA-acyl-glucuronide.
↵b Because of extensive protein binding of MPA, free drug MPA concentration can be higher, although the total MPA concentration is within the target range. Therefore, under circumstances of altered protein binding, total MPA levels are difficult to assess.
↵c This recommendation is under assumption of dosage linearity in MPA pharmacokinetics, which may not exist in all cases.