Managing Delayed or Missed Doses of Prolonged-Release Tacrolimus in Transplant Recipients: Implications for Drug Exposure and Recovery Strategies.

In lifelong immunosuppressive therapy, missed doses of prolonged-release tacrolimus are almost inevitable and may reduce drug exposure, compromising transplant outcomes. Using pharmacokinetic models, we simulated delayed and missed doses in virtual kidney and liver transplant recipients. Our simulations showed that a missed dose significantly lowers exposure, with recovery taking 2-4 days. For delays shorter than 12 h, the full dose should be taken immediately; for delays between 12 and 24 h, half the dose should be administered; for a missed dose, 150% should be given at the next intake. These strategies may help maintain therapeutic exposure and preserve transplant outcomes.