Envarsus Monitoring Guidelines

Early Monitoring Strategy

• During the immediate post-operative period, measure trough levels every other day until target levels are reached, even before steady state is achieved, for patients on Envarsus, according to Kidney International 1
• Draw blood samples exactly 24 hours after the previous dose and immediately before the next scheduled dose for patients on Envarsus 2

Optimal Sampling Window

• The acceptable window for trough sampling is within 24 hours (±2 hours) of the next scheduled dose to ensure accuracy for patients on Envarsus 2
• Samples drawn outside this window will not represent true trough concentrations and may lead to inappropriate dosing decisions for patients on Envarsus 2

Post-Steady State Monitoring Frequency

• Once stable therapeutic levels are achieved after the initial 7-day period, reduce monitoring frequency to every 1-2 weeks for the first 1-2 months post-transplant for patients on Envarsus 2
• After the first 2 months, monitor every 1-2 months for stable outpatients on Envarsus 2
• Increase monitoring frequency to every 2-3 days whenever medications affecting CYP3A4 metabolism are added or discontinued for patients on Envarsus 3

Critical Pitfalls to Avoid

• Do not use the 12-hour sampling timeframe that applies to twice-daily tacrolimus formulations—Envarsus requires 24-hour trough sampling, as recommended by Praxis Medical Insights 2
• Avoid collecting samples after a dose rather than before, as this will result in falsely elevated readings that do not reflect trough concentrations for patients on Envarsus 2