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[Cyclosporin interactions in kidney transplants]
F A Díaz Couselo1, F Porato, M Turín
1Unidad Renal, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina.
Medicina
|January 1, 1992
Summary
Cyclosporine, an immunosuppressant, is metabolized by liver enzymes. Concomitant use of drugs like isoniazid can significantly alter Cyclosporine levels in renal transplant patients, requiring careful monitoring.
Area of Science:
- Pharmacology
- Nephrology
- Transplantation
Background:
- Cyclosporine improves allograft survival in renal transplant recipients.
- Cyclosporine is metabolized by hepatic cytochrome P-450IIIA enzymes.
- Drug interactions often involve agents affecting the cytochrome P-450 system.
Observation:
- A review of 53 renal transplant patients (1985-1991) analyzed Cyclosporine levels, dosage, and drug interactions.
- Cyclosporine assays evolved from polyclonal to specific monoclonal antibodies, impacting measured levels.
- The recommended therapeutic range for Cyclosporine is 100-400 ng/ml.
Findings:
- Three cases of probable pharmacokinetic interactions with Cyclosporine are presented.
- One patient receiving isoniazid (150 mg/day) showed markedly elevated Cyclosporine levels (600-2085 ng/ml) despite dose reduction.
- Reducing isoniazid dosage led to decreased Cyclosporine levels, suggesting isoniazid inhibits Cyclosporine metabolism.
Implications:
- Isoniazid may inhibit Cyclosporine metabolism, increasing its blood concentration.
- Close monitoring of Cyclosporine levels is crucial when co-administered with potential interacting drugs like isoniazid.
- Understanding these interactions is vital for optimizing immunosuppression and preventing toxicity in transplant patients.