| Trough (mcg/mL)
|
Recommendation
|
| 0.0 to 0.6
|
Increase dose by 100 mg and recheck trough on day 5 of new regimen
|
| 0.7 to 0.9
|
Increase dose by 50 mg and recheck trough on day 5 of new regimen
|
| 1.0 to 4.0
|
At target, no dose adjustment needed
|
| 4.1 to 5.5
|
Decrease dose by 50 mg and recheck trough on day 5 of new regimen
|
| 5.6 to 7.9
|
Hold dose. Follow daily trough levels, then restart when trough is ≤2.5 at a dose decreased by 100 mg. Recheck trough on day 5 of new regimen.
|
| ≥8.0
|
Hold dose. Follow daily trough levels, then restart when trough is ≤2.5 at a dose decreased by 50%. Recheck trough level on day 5 of new regimen.
|
