Ercp

Placement of temporary foreign body (e.g., Hickman cath)

One preoperative dose plus 1-5 postoperative days

Indwelling vascular prosthesis (e.g., prosthetic graft)

Joint replacement

Prosthetic abdominal wall mesh

Dental surgery requiring surgical intervention are encountered. Small bowel obstruction, or paralytic ileus are important considerations in this regard.

Although both cyclosporine and tacrolimus are available for intravenous use, the cremophore vehicle used to solubilize these agents has been associated with important toxicity. Therefore, even when clinical situations suggest gastrointestinal absorption may be compromised, including those causing increased motility (e.g., diarrhea), decreased absorption (e.g., small bowel obstruction) or during external biliary drainage, efforts to persist with oral administration are usually exhausted before proceeding with parenteral dosing. It is frequently possible to achieve adequate circulating drug levels when Cy or Tcl is administered through a nasogastric tube (the tube is clamped for 30-60 minutes). Cyclosporine or tacrolimus levels are monitored daily when concerns regarding absorption are apparent. Intravenous Cy or Tcl is usually reserved for situations when poor absorption has been documented with low circulating drug concentrations.

Azathioprine is also available as an intravenous preparation; it is administered at an equivalent (mg for mg) dose.

Mycophenolate mofetil is not clinically available in a parenteral form. Accordingly, this drug is usually transiently discontinued when oral administration is not feasible.

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