lower anti-rejection drugs II

Since both Prograf and Rapamune both have tests to determine blood levels, is there any reason not to bring these levels to within the therapeutic dosage?  Is there a fear that even if getting them within therapeutic levels by adjusting dosages, that by lowering them too quickly, a rejection could be sparked?

If a low dosage such as 1 mg/day Prograf results in 2x the therapeutic level, is it considered risky to go down to 0.5 mg/day?

Lastly, do you know of many patients on both Prograf and Rapamune?  Would the goal be to migrate to one or the other but not both?

[Thomas D Schiano, MD]

as time elapses from the transplant the body develops tolerance so we can run the trough levels a little bit lower.  the goal is to be on as small an amount of meds as possible.  We have many patients on both prograf and rapa.  if the indication for the rapa is renal failure then usually its used as monotherapy.  if the indication is cancer prevention small doses of both are often used.