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[Music] tachrolimus the generic name is the cornerstone anti-rejection drug for patients after transplant providing the most protection from transplant rejection patients will take this medication most commonly in the form of long acting 24 hours duration or short acting 12 hours duration as part of the immunosuppression regimen while it does its job very well its a double-edged sword that we must closely monitor what does that mean it can be toxic to the kidneys causing neurological symptoms make blood sugar difficult to control and cause abnormalities with minerals and acids in the bloodstream as you can see its a balancing act to make sure that there is enough tacrolimus to prevent rejection but not so much to cause problems for this reason we must monitor the level of the chronic in the bloodstream regularly and adjust each patients dose ingly when your transplant provider checks your tachromius level they are looking for a trough level whats a trough level think about a wave w