Cyclosporine: Difference between revisions
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==Adult Dosing== | ==Adult Dosing== | ||
===Organ transplant rejection prophylaxis=== | ===Organ transplant rejection prophylaxis=== | ||
* Dosing protocols vary | *Dosing protocols vary | ||
* Start: 7- | *Start: 7-9mg/kg/day PO divided BID; give 1st dose 4-12 hr pre-transplant or postop | ||
* For heart, kidney, or liver transplant, adjust dose based on target levels, rejection status, adverse effects | *For heart, kidney, or liver transplant, adjust dose based on target levels, rejection status, adverse effects | ||
===Rheumatoid arthritis, severe=== | ===Rheumatoid arthritis, severe=== | ||
* Start: 2. | *Start: 2.5mg/kg/day PO divided BID, increase 0.5-0.75mg/kg/day after 8 wk and after 12 wk; Max: 4mg/kg/day | ||
* Use alone or with methotrexate; decreased 25-50% PRN adverse effects, discontinue if no benefit by 16 wks | *Use alone or with methotrexate; decreased 25-50% PRN adverse effects, discontinue if no benefit by 16 wks | ||
===Psoriasis, severe recalcitrant plaque=== | ===Psoriasis, severe recalcitrant plaque=== | ||
* Start: 2. | *Start: 2.5mg/kg/day PO divided BID, increase 0.5mg/kg/day q 2 wk after 4 wk; Max: 4mg/kg/day | ||
* Decrease 25-50% PRN adverse effects, discontinue if inadequate response after 6 weeks on max tolerated dose | *Decrease 25-50% PRN adverse effects, discontinue if inadequate response after 6 weeks on max tolerated dose | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===Organ transplant rejection prophylaxis=== | ===Organ transplant rejection prophylaxis=== | ||
* Dosing protocols vary | *Dosing protocols vary | ||
* Start 7- | *Start 7-9mg/kg/day PO divided BID, give 1st dose 4-12 hr pre-transplant or post op | ||
* For heart, kidney, or liver transplant, adjust dose based on target levels, rejection status, adverse effects | *For heart, kidney, or liver transplant, adjust dose based on target levels, rejection status, adverse effects | ||
==Special Populations== | ==Special Populations== | ||
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**rheumatoid arthritis or psoriasis: contraindicated in renal impairment | **rheumatoid arthritis or psoriasis: contraindicated in renal impairment | ||
*Pediatric: | *Pediatric: | ||
** transplant: no adjustment | **transplant: no adjustment | ||
===Hepatic Dosing=== | ===Hepatic Dosing=== | ||
*Adult: not defined, caution advised | *Adult: not defined, caution advised | ||
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*renal impairment (RA or psoriasis use) | *renal impairment (RA or psoriasis use) | ||
*malignancy (RA or psoriasis use) | *malignancy (RA or psoriasis use) | ||
*PUVA/UVB | *PUVA/UVB treatment (psoriasis use) | ||
*concurrent immunosuppressants (psoriasis use) | *concurrent immunosuppressants (psoriasis use) | ||
*coal tar | *coal tar treatment (psoriasis use) | ||
*concomitant XRT (psoriasis use) | *concomitant XRT (psoriasis use) | ||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
* | *hypertension, severe | ||
*immunosuppression | *immunosuppression | ||
*infection, severe | *infection, severe | ||
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===Common=== | ===Common=== | ||
*BUN, | *BUN, creatinine elevated | ||
* | *hypertension | ||
*hirsutism | *hirsutism | ||
*infection | *infection | ||
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==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 8.4h | ||
*Metabolism: | *Metabolism: liver extensively, GI tract, kidney; CYP450 | ||
*Excretion: | *Excretion: bile primarily, urine 6% | ||
==Mechanism of Action== | ==Mechanism of Action== | ||
exact mechanism of action unknown; inhibits T-lymphocytes | |||
==Comments== | ==Comments== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] | ||
epocrates |
Latest revision as of 07:21, 11 August 2016
Administration
- Type: immunosuppressant
- Dosage Forms: 25,100; 100/mL
- Routes of Administration: PO, injection
- Common Trade Names: Sandimmune
Adult Dosing
Organ transplant rejection prophylaxis
- Dosing protocols vary
- Start: 7-9mg/kg/day PO divided BID; give 1st dose 4-12 hr pre-transplant or postop
- For heart, kidney, or liver transplant, adjust dose based on target levels, rejection status, adverse effects
Rheumatoid arthritis, severe
- Start: 2.5mg/kg/day PO divided BID, increase 0.5-0.75mg/kg/day after 8 wk and after 12 wk; Max: 4mg/kg/day
- Use alone or with methotrexate; decreased 25-50% PRN adverse effects, discontinue if no benefit by 16 wks
Psoriasis, severe recalcitrant plaque
- Start: 2.5mg/kg/day PO divided BID, increase 0.5mg/kg/day q 2 wk after 4 wk; Max: 4mg/kg/day
- Decrease 25-50% PRN adverse effects, discontinue if inadequate response after 6 weeks on max tolerated dose
Pediatric Dosing
Organ transplant rejection prophylaxis
- Dosing protocols vary
- Start 7-9mg/kg/day PO divided BID, give 1st dose 4-12 hr pre-transplant or post op
- For heart, kidney, or liver transplant, adjust dose based on target levels, rejection status, adverse effects
Special Populations
- Pregnancy Rating: Pregnancy Category C
- Lactation risk: safety unknown
Renal Dosing
- Adult:
- transplant: no adjustment
- rheumatoid arthritis or psoriasis: contraindicated in renal impairment
- Pediatric:
- transplant: no adjustment
Hepatic Dosing
- Adult: not defined, caution advised
- Pediatric: not defined, caution advised
Contraindications
- Allergy to class/drug
- uncontrolled hypertension (RA or psoriasis use)
- renal impairment (RA or psoriasis use)
- malignancy (RA or psoriasis use)
- PUVA/UVB treatment (psoriasis use)
- concurrent immunosuppressants (psoriasis use)
- coal tar treatment (psoriasis use)
- concomitant XRT (psoriasis use)
Adverse Reactions
Serious
- hypertension, severe
- immunosuppression
- infection, severe
- opportunistic infection
- BK virus-associated nephropathy
- hyperkalemia, severe
- nephrotoxicity
- hepatotoxicity
- glomerular capillary thrombosis
- diabetes mellitus
- leukopenia
- thrombocytopenia
- hemolytic anemia
- malignancy
- malignancy
- seizures
- encephalopathy
- posterior reversible encephalopathy syndrome
- neurotoxicity
- intracranial hypertension
- optic disc edema
- MI
- depression
- pancreatitis
- GI bleeding
Common
- BUN, creatinine elevated
- hypertension
- hirsutism
- infection
- tremor
- gingival overgrowth
- headache
- hypertriglyceridemia
- nausea/vomiting
- diarrhea
- leg cramps
- paresthesia
- influenza-like symptoms
- edema
- dizziness
- rash
- acne
- chest pain
- stomatitis
- hypomagnesemia
- arthralgia
- flushing
- bronchospasm
- hyperkalemia
- hyperglycemia
- hyperuricemia
Pharmacology
- Half-life: 8.4h
- Metabolism: liver extensively, GI tract, kidney; CYP450
- Excretion: bile primarily, urine 6%
Mechanism of Action
exact mechanism of action unknown; inhibits T-lymphocytes
Comments
See Also
References
epocrates