The Pharmaceutical Journal
Vol 280 No 7496 p389
5 April 2008

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Astellas asks pharmacists to check tacrolimus brand

Pharmacists should check that they dispense the correct brand of tacrolimus for transplant patients following several reports of potentially serious dispensing errors involving Prograf and Advagraf. Patients should be maintained on the same brand unless a change is instigated by their transplant specialist.

Astellas has received reports of pharmacists dispensing the once-daily modified release preparation Advagraf instead of the twice-daily preparation Prograf. The company has also received reports of a GP incorrectly prescribing tacrolimus MR — Advagraf — for a patient usually maintained on Prograf.

Tacrolimus has a narrow therapeutic index and the two brands are not freely interchangeable, writes Astellas in a letter to the President of the Royal Pharmaceutical Society. When changes are made a proportion of patients will require dose adjustments to ensure that drug levels are optimal.

Switching between brands is possible under the supervision of a transplant specialist but the company recommends that therapeutic drug monitoring is undertaken before and within two weeks after conversion.