Adherence to immunosuppressant medication is essential for achieving successful outcomes in graft-vs-host disease (GVHD) management after allogeneic stem cell transplantation (alloSCT). Tacrolimus, the key immunosuppressant, has a narrow therapeutic index, meaning even a few missed doses, incorrect timing, or drug-drug or drug-food interactions can quickly result in subtherapeutic blood levels.
Low tacrolimus levels put the patient at an increased risk for GVHD—both acute and chronic—onset or flares. Conversely, excess tacrolimus dosing can lead to adverse effects, such as nephrotoxicity, hypertension, or neurotoxicity (eg, tremors, headache) or to an increased risk for infection. Maintaining adherence is further complicated by tacrolimus’s twice-daily dosing schedule.
Oncology nurses need to understand current research on medication adherence, strategies to improve adherence, and practice implications. By understanding the importance of pill counts and potential risk factors for poor adherence, oncology nurses can better tailor interventions through a collaborative approach.