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Influence of oral felodipine on serum cyclosporine concentrations
D J Cohen1, S N Teng, G B Appel
1Department of Medicine, Columbia University College of Physicians & Surgeons, Columbia Presbyterian Medical Center, New York, NY.
Insights
Felodipine effectively lowers blood pressure in renal transplant patients taking cyclosporine. This study found felodipine did not significantly alter cyclosporine levels or harm kidney function.
Area of Science:
- Nephrology
- Pharmacology
- Transplantation
Background:
- Hypertension and nephrotoxicity are common complications in renal transplant recipients treated with cyclosporine.
- Calcium-channel blockers are often preferred antihypertensives due to renal vasodilation.
- Many calcium-channel blockers can inhibit cyclosporine clearance, increasing toxicity risks.
Purpose of the Study:
- To evaluate the safety and efficacy of felodipine as an antihypertensive agent in renal transplant patients on cyclosporine.
- To assess the impact of felodipine on serum cyclosporine levels and allograft function.
Main Methods:
- A study involving thirteen hypertensive renal transplant patients on stable cyclosporine doses.
- Felodipine was added to their antihypertensive regimens, and cyclosporine levels were monitored.
- Blood pressure and serum creatinine were measured before and during felodipine treatment.
Main Results:
- Mean trough serum cyclosporine concentration showed a slight, non-significant increase after felodipine administration.
- Significant reductions in both systolic (approx. 10 mmHg) and diastolic (approx. 10 mmHg) blood pressure were observed.
- Serum creatinine levels remained unchanged, indicating preserved allograft function.
Conclusions:
- Felodipine is an effective antihypertensive medication for renal transplant recipients treated with cyclosporine.
- Felodipine does not significantly affect cyclosporine blood levels or negatively impact kidney allograft function.
- The addition of felodipine offers a safe therapeutic option for managing hypertension in this patient population.
Abstract:
Hypertension and nephrotoxicity are frequent in renal transplant patients treated with cyclosporine. Calcium-channel blockers, because of their vasodilatory effects on the renal afferent arteriole, may be the anti-hypertensive agents of choice in this population. Unfortunately, many calcium channel blockers inhibit the clearance of cyclosporine, resulting in elevated blood levels, and worsening nephrotoxicity. Thirteen hypertensive renal transplant patients, on stable cyclosporine doses and with stable cyclosporine blood levels, had felodipine added to their antihypertensive regimens. The effect on cyclosporine level was measured. Mean trough serum cyclosporine concentration increased slightly, from 122.8 +/- 51.8 ng/ml to 143.1 +/- 81.9 ng/ml with chronic felodipine administration (p = NS). Mean systolic and diastolic pressures both fell significantly, by approximately 10 mmHg (systolic from 161 +/- 14 to 152 +/- 13 mmHg; diastolic from 100 +/- 6 to 90 +/- 7 mmHg). Serum creatinine remained unchanged. Four patients eventually discontinued felodipine. There was no significant change in their mean trough serum cyclosporine concentration when felodipine was discontinued. Thus, felodipine is an effective anti-hypertensive medication in cyclosporine-treated renal transplant recipients, without significant effect on cyclosporine blood levels, or adverse effect on allograft function.