Dr Varuna Aluvihare attended the Listen Group Zoom meeting on 17 March 2025 to present news about Envarsus – a new version of tacrolimus.  The majority of Kings Liver Transplant patients currently take Prograf or Advagraf.  Prograf is a twice daily medicine, meaning two three hour windows per day without food.  Advagraf is more widely used and is a slow release medication taken once per day.

Envarsus became available about four years ago and its formulation means that a lower dose produces the same levels, which could be a real benefit to patients in terms of reduced side effects.  It was originally evaluated in a small number of patients who suffered side effects or needed large doses of Advagraf and this worked well for them.  Just over a year ago, Envarsus was trialled more widely amongst newly transplanted patients at Kings, where results could be closely monitored. There are now around 120-130 patients successfully taking this formulation.

Having seen this success, the team at Kings now plan to make Envarsus more widely available and offer it where suitable to post transplant patients currently taking Advagraf or Prograf, who are very stable and have satisfactory blood results. It is in no way obligatory – patients will be asked at a future clinical appointment whether they would like to be moved over. 

This is an exciting development – not only is there a possibility of reducing side effects of previous formulations – but a new way of monitoring bloods will go alongside it.  Anyone who agrees potentially to move to Envarsus will be looked after under an innovative clinic – Fiona and the team in the Long Term Follow Up Clinic, alongside Jake and the team in Liver Pharmacy.  Participants will be trained to do a special blood test at home so that they can be closely monitored without the need for frequent visits to Kings – results can be sent to Kings and the Team will phone to convey results.  This could potentially feed into a new model of care so is a very exciting development.

However, any change can be accompanied by concerns, however slight.  Kings Liver Pharmacy – Jake and the team – have given the following comments to reassure potential participants.

“1.     We will always try to use the formulations that we feel offer the best outcomes for our patients.  We are constantly reviewing our Envarsus patient cohort to evaluate this.

  1. Switching is entirely down to the individual. There is no obligation to switch and from Liver Pharmacy’s perspective they would much rather a patient remained on their Advagraf if a potential switch would cause undue stress or worry.  Advagraf is also a great medicine!
  2. If patients find themselves in a position where a switch is being offered in the future, speaking to those who take Evarsus already may be useful before committing, to gain first hand insight into patient experience.

The Kings Liver Pharmacy team hope this helps and ask that patients don’t hesitate to reach out to them if they can be of assistance.  Please use the following email address kch-tr.liverpharmacy@nhs.net