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Published on: November 8, 2015
Factors Influencing Cyclosporine Trough and Two-Hour Post-dose Concentrations in Children with Idiopathic Nephrotic
Priyatharsini Vellingiri1, Sriram Krishnamurthy2, Rajan Sundaram1
1Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Objective:
To determine the cyclosporine trough (C0) and two-hour post-dose concentrations (C2) in children with nephrotic syndrome (NS) and study the factors influencing them.
Methods:
In this ambispective cohort study, children with NS (including frequently relapsing, steroid-dependent and steroid-resistant nephrotic syndrome) on cyclosporine therapy were enrolled. Clinical and laboratory data were recorded. C0 and C2 were estimated using liquid chromatography mass spectrometry.
Results:
Among 27 patients with a mean (SD) age of 6.4 (4.1) years, the median (Q1, Q3) of C0 and C2 were 114.8 (86.1, 186.3) ng/mL and 661.6 (442.1, 884.6) ng/mL, respectively. At a mean (SD) cyclosporine dose of 4.1 (0.8) mg/kg/day, 12 (44%) patients had C0 above and 4 (15%) below the therapeutic range (80-120 ng/mL). C2 levels were outside the recommended ranges in 17 (63%) children, within range in 7 (26%), and below in 3 (11%). Capsule users had higher C0 than syrup users. Amlodipine therapy was associated with higher C0 levels.
Conclusion:
Nearly half the children had C0 and C2 levels outside the therapeutic range. Dosage form and amlodipine influenced C0, not C2 concentrations.
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