Monitoring of immunosuppression therapy in renal transplant recipients is essential for good patient and graft survival. Monitoring includes frequent laboratory assays of serum immunosuppression levels, patient visits to assess and treat side effects, and vigilance for medication interactions. We review the various immunosuppression medications commonly used in renal transplantation, including usual dosing and side effects. Monitoring assays are discussed, as well as the frequency of monitoring and patient visits. Finally, we discuss several common clinical scenarios that often require adjustment of immunosuppression medications or regimens.