Tacrolimus, Whole Blood

CPT: 80197
Print Share

Test Details

Synonyms

  • FK506
  • Prograf®
  • Protopic®

Use

Tacrolimus is an immunosuppressive drug that is believed to prevent rejection in transplantation patients. Measurement of tacrolimus blood levels may be of use in monitoring patients receiving this drug.

Limitations

Specimens from patients who have circulating human antimouse (HAMA) as a result of having received mouse monoclonal antibodies may give falsely elevated or depressed results in this assay.

Methodology

Liquid chromatography/tandem mass spectrometry (LC/MS-MS)

Reference Interval

Clinical studies have shown that patients administered 0.07 mg/kg Prograf® obtain an optimal response to the drug at the following trough levels:

• Trough (immediately following transplant): 15.0 ng/mL

• Trough (steady-state, two weeks or more after transplant): 3.0−8.0 ng/mL

Additional Information

Tacrolimus, previously known as FK506, is an immunosuppressive drug derived from Streptomyces tsulenbaensis. It has been shown to be effective for the treatment of rejection following liver and kidney transplantations. Clinical trials are continuing for a variety of indications. Tacrolimus inhibits T-lymphocyte activation by inhibition of the phosphatase activity of calcineurin, although the exact mechanism of action is not known. Tacrolimus is bound to plasma proteins and is highly bound to erythrocytes (ratio of whole blood:plasma ranging from 12 to 67). Tacrolimus may be administered IV or orally. Absorption from the GI tract is variable and irregular. Peak blood concentrations are achieved at 1.5 to 3.5 hours. The elimination half-life from whole blood is 11.7 hours in liver transplant patients. Tacrolimus can cause nephrotoxicity, particularly when used in high doses. Care must be taken if tacrolimus is used in combination with other immunosuppressive drugs, particularly cyclosporine. Drugs found to increase tacrolimus levels include diltiazem, verapamil, clotrimazole, fluconazole, ketoconazole, voriconazole, clarithromycin, erythromycin, nelfinavir, ritonavir, as well as grapefruit juice. Decreased tacrolimus levels have been found with coadministration of rifampicin, phenytoin, carbamazepine, phenobarbital, octreotide, and St John's wort.1

Specimen Requirements

Specimen

Whole blood

Volume

1 mL

Minimum Volume

0.6 mL

Container

Lavender-top (EDTA) tube or green-top (heparin) tube

Storage Instructions

Room temperature

Causes for Rejection

Plasma or serum specimen

Clinical Information

Footnotes

1. Bernardo JF, McCauley J. Drug therapy in transplant recipients. Special considerations in the elderly with comorbid conditions. Drugs Aging. 2004; 21(5):323-348. 15040759

References

Alak AM. Measurement of tacrolimus (FK506) and Its metabolites: A review of assay development and application in therapeutic drug monitoring and pharmacokinetic studies. Ther Drug Monit. 1997; 19(3):338-351. 9200777

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
700248 Tacrolimus (FK506), Blood 74097-7 700249 Tacrolimus (FK506), Blood ng/mL 74097-7
Reflex Table for Tacrolimus (FK506), Blood
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 007000 See below: 007000 See below: N/A

For Providers

Please login to order a test.

 

© 2017  Laboratory Corporation of America® Holdings and Lexi-Comp Inc. All Rights Reserved.

CPT Statement/Profile Statement

The LOINC® codes are copyright © 1994-2017, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf