Managing immunosuppression in organ transplantation is a complex and risky procedure for transplant physicians as easy-to-use tests to quantify the drug dose for a particular transplant recipient is not yet available We still follow the rule of the thumb to monitor immunosuppression in transplant recipients. Newer drugs available over the last decade or so, have certainty added to the immunosuppressive armamentorium of transplant physicians. However, optimal use of these drugs still remains elusive including the understanding of methods of monitoring efficacy and toxicity. It took many years of learning and experience for us to use cyclosporine optimally in kidney transplantation. Tacrolimus is being increasingly used in organ transplantation in the western world. Its availability in India poses greater challenges and responsibilities. Consensus-based guidelines for use of calcineurin Inhibitors (CNI) in kidney transplantation are required. These consensus guidelines will be useful to practicing transplant physicians in their day-to-day practice and help them optimize the use of CNIs in kidney transplantation in our country.