Impact of clinical pharmacist-led medication management and education on tacrolimus therapeutic control

Introduction – The management of Tacrolimus in pediatric bone marrow transplantation (BMT) presents significant challenges owing to its narrow therapeutic index and considerable pharmacokinetic variability. This study assesses the effects of clinical pharmacist interventions, particularly the resolution of drug-related problems (DRPs) and caregiver and nursing staff education, on stabilizing tacrolimus blood concentrations. Methods – This prospective interventional study was conducted across five hospitals in Istanbul from June 2024 to January 2026. The study comprised 65 pediatric patients, their caregivers, and 50 nurses. Clinical pharmacists identified Drug-Related Problems (DRPs) utilizing the PCNE V9.00 system and delivered both verbal and written educational interventions. Knowledge assessments and tacrolimus levels were evaluated at baseline, post-education, and at the 3-month follow-up. Results – Out of the 35 pharmacist interventions conducted, 77.1% were successfully resolved. The proportion of patients within the therapeutic range (5–20 ng/ml) increased from 52.3% at baseline to 84.4% following the educational intervention and remained at 82.5% after 3 months (p < 0.001). Both caregivers and nurses demonstrated substantial and enduring improvements in their pharmacological knowledge and rational medication-use behaviors (p < 0.001). Notably, elevated knowledge levels and the presence of “unresolved DRPs” (p < 0.05) were identified as critical factors affecting tacrolimus stability, thereby adding an essential layer of control alongside traditional markers such as C-reactive protein (CRP) and renal function. Discussion – Clinical pharmacist-led interventions substantially improve the management of tacrolimus therapy in pediatric bone marrow transplantation. Systematic education and proactive resolution of drug-related problems are essential for optimizing medication levels and safeguarding patient safety by addressing critical behavioral and systemic factors in post-transplant management.