Envarsus Xr

  • Organ rejection prophylaxis

Envarsus Xr Generic Name & Formulations

General Description

Tacrolimus 0.75mg, 1mg, 4mg; ext-rel tabs.

Pharmacological Class

Immunosuppressant (calcineurin-inhibitor).

How Supplied

Ext-rel tabs—30, 100

Generic Availability


Envarsus Xr Indications


Organ rejection prophylaxis in de novo kidney transplant patients or in stable kidney transplant patients converted from tacrolimus immediate-release formulations, in combination with other immunosuppressants.

Envarsus Xr Dosage and Administration


Swallow whole. Take once daily in the morning, preferably on an empty stomach. De novo: initially 0.14mg/kg/day. Titrate dose based on tolerability and to achieve target whole blood trough concentration ranges. During Month 1: 6–11ng/mL; >Month 1: 4–11ng/mL. Converting from tacrolimus immediate-release: give 80% of total daily dose of the immediate-release product; monitor and titrate dose to achieve ranges 4–11ng/mL. Hepatic impairment: severe (Child-Pugh ≥10): use lower initial dose; moderate: monitor. Black patients may require higher doses. See full labeling.


Not established.

Envarsus Xr Contraindications

Not Applicable

Envarsus Xr Boxed Warnings

Boxed Warning

Malignancies. Serious infections.

Envarsus Xr Warnings/Precautions


Not interchangeable or substitutable with other tacrolimus products. Increased risk of lymphomas and other malignancies (eg, skin). Avoid sun, UV light. Epstein Barr Virus seronegative; monitor. Increased risk of infections (eg, bacterial, viral, fungal, protozoal), opportunistic infections including polyoma virus, JC virus-associated progressive multifocal leukoencephalopathy, cytomegalovirus; monitor. New-onset diabetes: monitor blood glucose levels esp. in Black and Hispanic patients. Monitor for neurotoxicity; consider dose reduction or discontinuation if occurs. Renal impairment; monitor and consider dose reduction. Obtain tacrolimus whole blood concentrations (see full labeling), serum creatinine, and serum potassium periodically. Avoid in congenital long QT syndrome. CHF, bradyarrhythmias, concomitant antiarrhythmic drugs, or electrolyte disturbances: consider obtaining ECGs and monitor electrolytes periodically. Elderly. Labor & delivery. Advise females of reproductive potential and male patients to use appropriate contraception prior to initiation. Pregnancy: monitor. Nursing mothers.

Envarsus Xr Pharmacokinetics

See Literature

Envarsus Xr Interactions


Concomitant live vaccines: not recommended. Avoid grapefruit/grapefruit juice, alcohol. Concomitant mycophenolic acid (MPA) products; monitor and reduce MPA dose as needed. Concomitant strong CYP3A inhibitors (eg, protease inhibitors, azole antifungals, clarithromycin, troleandomycin, chloramphenicol, nefazodone, cobicistat) or inducers (eg, antimycobacterials, anticonvulsants, St. John's wort): adjust dosing regimen, closely monitor tacrolimus blood concentrations and for QT prolongation. Concomitant voriconazole, posaconazole: give ⅓ of original dose. Concomitant mild or moderate CYP3A inhibitors (eg, erythromycin, calcium channel blockers, amiodarone, danazol, ethinyl estradiol, cimetidine, lansoprazole, omeprazole, azole antifungals, imatinib, nilotinib, letermovir) or inducers (eg, methylprednisolone, prednisone), magnesium and aluminum hydroxide antacids, metoclopramide: monitor and adjust dose as needed. Concomitant potassium-sparing diuretics, ACEIs, ARBs may increase risk of hyperkalemia; monitor. Additive nephrotoxicity with CYP3A inhibitors, aminoglycosides, ganciclovir, amphotericin B, cisplatin, nucleotide reverse transcriptase inhibitors, protease inhibitors. Concomitant with direct acting antivirals; monitor closely.

Envarsus Xr Adverse Reactions

Adverse Reactions

Diarrhea, anemia, UTI, hypertension, tremor, constipation, diabetes mellitus, peripheral edema, hyperkalemia, headache, increased creatinine; infections, malignancies (lymphomas, skin), post-transplant lymphoproliferative disorder, nephrotoxicity or neurotoxicity (esp. in high doses), posterior reversible encephalopathy syndrome, QT prolongation, pure red cell aplasia (consider discontinuation).

Envarsus Xr Clinical Trials

See Literature

Envarsus Xr Note

Not Applicable

Envarsus Xr Patient Counseling

See Literature