Suppress antibody production and ability to recognize antigen, inhibit IL-2 release from macrophages

Used for both acute rejection and maintenance

Dose varies widely; As usual, minimal dosing or avoidance is best

S/E: hypertension, osteopenia, diabetes, dyslipidemia

Prevents T-cell activation though inhibition of several critical transcription factors, including IL-2

Used for maintenance therapy and/or rejection (unlike Cyclosporine)

Dose 0.1 mg/kg daily in BID doses is a starting dose

S/E: Neurotoxicity (seizures, paresthesias, delirium, tremor; usually subsides with dosage reduction), DM, HTN, Nephrotoxicity

Metabolized by P450, therefore meds that inhibit P450 will raise drug levels, meds that induce P450 will lower levels and ↑ rejection

Tacrolimus levels after transplant: During 0-6 months: 10-15; After 6 months: 5-10