cyclosporine

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

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Feb 16, 2017 | Posted by in PHARMACY | Comments Off on cyclosporine

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