Q: My 27 years old friend had a kidney transplant last year. His mother donated the kidney. Recently his creatinine level increased from 1.3 to 1.7 mg/dl. Biopsy showed mild rejection and was treated with methyl prednisolone 500 mg injection for three days when his creatinine level came back again to normal. Before the rejection his anti-rejection medicines were Pan Graf 1.5, Myfortic 360 and Wysolone 7.5. After the rejection, his dose was increased to Pan Graf 2, Myfortic 720, Wysolone 20. After continuing on the same dose for a month his Tacrolimus (Tac) level increased to 8.7. The surgeon is telling to reduce Myfortic to 360 and maintain the same dose of Pan Graf and Wysolone. But the nephro-physician is telling to reduce Pan Graf to 1.5-1 as Tac level is high, to keep the same dose of Myfortic and start taking Defcort 18 mg instead of Wysolone. Is there any advantage in taking Defcort instead of Wysolone? I have come to know that both the medicines have same side effects. Please advise.

A:Pan Graf is the brand name; the name of the medicine is tacrolimus. Similarly Myfortic brand contains mycophenolic acid. Blood tacrolimus levels should remain between 5 to 15 nanogram/mL; thus a level of 8.7 is within the acceptable range. Unless it increases rapidly and starts touching 15nanogram/mL, the current dose appears to be rational. With regard to Myfortic (mycophenolic acid), the internationally recommended and accepted dose is 720mg twice daily. There is no mention of thrice daily schedule in any clinical trial. In any case overdose, even if given, does not cause toxicity. Normally we use Wysolone (prednisolone), which is a steroid, in kidney transplant cases. A dose of 20mg is quite rational. There is no advantage in replacing one tried-and-tested steroid with another steroid. Moreover deflazacort (Defcort) is not in vogue for kidney transplant patients. One should alter medicines when clearly clinically required. In short: prima facie the current dose appears to be quite rational. It is absolutely essential to ensure that transplant does not get rejected.