Class
- Immunosuppressive agent, immunomodulator
Cyclosporine
Commonly Prescribed for
(FDA approved in bold)
- Prophylaxis of organ rejection in patients with allogenic 1 kidney, liver, and heart transplants
- Rheumatoid arthritis
- Psoriasis
- Myasthenia gravis (MG)
- Leukemias refractory to routine treatment
- Aplastic anemia
- Ulcerative colitis
Cyclosporine
How the Drug Works
- Specifically and reversibly inhibits T-lymphocytes, especially T-helper cells. Also inhibits lymphokine production and release, including interleukin-2
Cyclosporine
How Long Until It Works
- Most patients with MG improve 1–2 months after starting treatment, but maximum improvement takes 6 or more months
Cyclosporine
If It Works
- Decrease dose of corticosteroids. Gradually reduce to the minimum dose needed to maintain clinical improvement
Cyclosporine
If It Doesn’t Work
- Consider alternative disease-modifying therapy or thymectomy
Cyclosporine
Best Augmenting Combos for Partial Response or Treatment-Resistance
- Often used with corticosteroids (prednisone), especially in the initial stages of treatment
Cyclosporine
Tests
- Obtain baseline CBC, magnesium, potassium, uric acid, lipids, blood urea nitrogen, and creatinine. Measure trough levels 1 month after starting determine dosing. Measure creatinine every 2–4 weeks for the first few months, then monthly, and then every 2–3 months when stable or when new medications are added. Measure CBC, uric acid, potassium and lipids every 2 weeks for the first 3 months, then monthly. Monitor blood pressure frequently (at least monthly)
Adverse Effects (AEs)
Cyclosporine
How Drug Causes AEs
- Uncertain
Cyclosporine
Notable AEs
- Hypertension, hirsutism, cramps, diarrhea, infection, hypomagnesemia
- Tremor, convulsions, paresthesias
Cyclosporine
Life-Threatening or Dangerous AEs
- Renal failure. Elevations of BUN and creatinine are common and are dose-related. Nephrotoxicity occurs in over 20% of patients
- Thrombocytopenia and microangiopathic hemolytic anemia
- Hyperkalemia
- Hepatotoxicity, usually in 1st month of therapy
Cyclosporine
Weight Gain
- Unusual
Cyclosporine
Sedation
- Not unusual
Cyclosporine
What to Do About AEs
- Renal function generally improves with dose reductions. Creatinine should be below 150% of baseline. Reduce dose by 25–50% for laboratory abnormalities
Cyclosporine
Best Augmenting Agents for AEs
- Most cannot be improved