American Journal of Nephrology
Clinical Study
Cyclosporine Dose Adjustment Using Levels Obtained Six Hours after the Morning Dose: Effect on Side Effects in Patients with Autoimmune DiseasesCantarovich M.a · Deschênes J.bDepartments of aMedicine and bOphthalmology, Royal Victoria Hospital, McGill University, Montreal, Que., Canada
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Article / Publication Details
Received: July 02, 1996
Accepted: September 06, 1996
Published online: October 28, 2008
Issue release date: 1997
Number of Print Pages: 8
Number of Figures: 0
Number of Tables: 0
ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)
For additional information: https://www.karger.com/AJN
Abstract
Cyclosporine (CsA) is frequently used for nontransplant indications such as autoimmune diseases. Unfortunately, side effects such as renal dysfunction and hypertension are frequently described in spite of close monitoring with CsA trough levels. The purpose of the present prospective cohort study was to use the CsA level obtained 6 h after the morning dose (T6) for CsA dose adjustment and its impact on observed side effects in 11 patients (44 ± 17 years) treated with CsA for autoimmune diseases. Patients were monitored for CsA-related side effects at each outpatient visit, including blood pressure measurement, CsA trough and T6 levels and routine laboratory tests. Changes in blood pressure and biochemical parameters were compared to the previous visit (n = 244) and a change > 30% was considered significant. Significant changes in monitored variables were observed in the following percentage of visits: increases in systolic/diastolic blood pressure (1.2), serum creatinine (6.1), potassium (0.8), and uric acid (6.3), and a decrease in magnesium (0.5). At the end of follow-up (20 ± 12.5 months), CsA dose was reduced from 4.8 ± 1.1 to 3.5 ± 1 mg/kg/day (p = 0.004); serum creatinine, potassium, uric acid, hemoglobin, total cholesterol, effective renal plasma flow and glomerular filtration rate did not differ from baseline. Alkaline phosphatase increased from 63 ± 19 to 82 ± 21 U/l (p = 0.04) and magnesium decreased from 0.85 ± 0.1 to 0.75 ± 0.1 mmol/l (p = 0.02). Transient hypertension and reversible renal dysfunction was seen in 2 patients, respectively. In conclusion, CsA monitoring according to T6 levels may allow a lower CsA dose than the one usually recommended and reduce the incidence of side effects in patients with autoimmune diseases.
© 1997 S. Karger AG, Basel
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Article / Publication Details
Received: July 02, 1996
Accepted: September 06, 1996
Published online: October 28, 2008
Issue release date: 1997
Number of Print Pages: 8
Number of Figures: 0
Number of Tables: 0
ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)
For additional information: https://www.karger.com/AJN
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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