Cyclosporine

Indications: severe active rheumatoid arthritis when conventional second-line therapy inappropriate or ineffective; graft-versus-host disease; atopic dermatitis and psoriasis.

Cautions: serum creatinine level should be monitored especially if dose increased or concomitant NSAIDs introduced or increased.

Contra-indications: in abnormal renal function, uncontrolled hypertension, uncontrolled infections, and malignancy. Measure serum creatinine at least twice before treatment and monitor every 2 weeks for first 3 months, then every 4 weeks (or more frequently if dose increased or concomitant NSAIDs introduced or increased; reduce dose if serum creatinine increases more than 30% above baseline in more than 1 measurement; if above 50%, reduce dose by 50% (even if within normal range) and discontinue if reduction not successful within 1 month; monitor blood pressure (discontinue if hypertension develops that cannot be controlled by antihypertensive therapy); monitor hepatic function if concomitant NSAIDs given.

Side Effects: tremors, Overgrowth of the gums, Unusual bleeding or bruising, Chills, Yellowing of the skin or eyes, Seizures, Decreased urination, Swelling (feet, ankles, lower legs, and hands), Weight gain, headache.

Drug Interactions: Several potential drug interactions.

Dose: by mouth, initially 2.5mg/kg daily in 2 divided doses, if necessary increased gradually after 6 weeks. Max. 4mg/kg daily. Discontinue if response is insufficient after 3 months.child and under 18 years, not recommended.