Cyclosporin

Indications & Dose:

 Severe active rheumatoid arthritis when conventional second line therapy inappropriate or ineffective; graft-versus-host diseas

DOSE

Refer to manufactuers

Contraindications:

Hypersensitivity to Cremophor EL (Sandimmune dosage forms)

Side Effects:

Cautions:

Precautions:

Renal disease, hepatic disease, concurrent nephrotoxic drugs; anaphylaxis possible with 1st IV dose; malabsorption syndromes

Interaction:

Allopurinol, amiodarone, chloroquine, clarithromycin, clonidine, clotrimazole, oral contraceptives, erythromycin, fluconazole, griseofulvin, itraconazole, ketoconazole, miconazole, roxithromycin, ticlopidine: Increased cyclosporine levels, potential for toxicity

Aminoglycosides, amphotericin B, , enalapril, melphalan, sulfonamides: Additive nephrotoxicity with cyclosporine

Anabolic steroids: Increased cyclosporine levels, potential for toxicity

Barbiturates, carbamazepine, nafcillin, pyrazinamide, phenytoin, sulfonamides: Reduced cyclosporine levels, potential for therapeutic failure

Calcium channel blockers: Diltiazem, verapamil, increase cyclosporine levels; israpidine, nifedipine, nitrendipine do not interact

Cisapride, metoclopramide: Increased bioBrands Available with Cost and serum levels of single-dose cyclosporine

Digitalis glycosides: Cyclosporine in patients stabilized on digitalis leads to increased levels and potential toxicity

Doxorubicin, imipenem: CNS toxicity

HMG-CoA reductase inhibitors: Increased risk of reversible myopathy

Methotrexate: increased toxicity of both agents

NSAIDs: Increased risk of cyclosporine nephrotoxicity

Rifampin: Reduced cyclopsorine levels, potential for therapeutic failure

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Headache, tremors

CV: Hypertension (50% of renal transplants; most cardiac transplants)

GI: Diarrhea, gum hyperplasia, hepatotoxicity, nausea, oral Candida, pancreatitis, vomiting

GU: Albuminuria, hematuria, proteinuria, renal failure

HEME: Leukopenia

METAB: Hypomagnesemia (related to neurotoxicity)

SKIN: Acne, hirsutism, rash

Patient And Carer Advice: