What is your approach to inpatient immunosuppression for a kidney transplant patient on home tacrolimus, prednisone, and mycophenolic acid who cannot tolerate anything by mouth?

When someone is NPO or cannot tolerate tacrolimus by mouth we give it sublingually. The sublingual dose is twice as potent as po so if someone is on 2 mg twice daily PO we would give 1 mg SL bid and monitor levels.

Mycophenolate mofetil is available IV and is a 1:1 dose.

Someone on 500 mg po bid MMF...

To piggyback onto @Dr. First Last's comprehensive reply is that those on Envarsus XR (once daily tacrolimus), one will convert back to immediate-release tacrolimus (Envarsus dose daily/0.8 and then divided into twice daily, e.g Envarsus 4 mg qd = tacrolimus 2.5 mg bid).

The mTORI like sirolimus and ...