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With all of the post-transplant patients we see in the ED, a refresher on the toxicities associated with the most common immunosuppressant medications is warranted.
Cyclosporine (Sandimmune® and Neoral®/Gengraf®) and tacrolimus (Prograf®) are both calcineurin inhibitors that inhibit activation and proliferation of T-lymphocytes and IL-2.
- Major concerns: Nephrotoxicity, drug interactions (CYP3A4)
- Adverse Effects:
o Electrolyte abnormalities: K+, ¯Mg+, glucose
o CNS: HA, tremor (statistically higher with tacrolimus)
o CV: HTN, lipids (increased with cyclosporine)
o End organ: hepatotoxicity, nephrotoxicity
o Cosmetic (cyclosporine specific): hirsutism, gingival hyperplasia, acne
Sirolimus/Rapamycin (Rapamune®) is an M-tor inhibitor that inhibits T-lymphocyte activation and proliferation.
- Major concerns: Drug interactions (CYP3A4)
- Adverse Effects:
o Delayed wound healing
o Leucopenia, thrombocytopenia
o Hypercholesterolemia