- Prophylaxis of organ rejection in kidney, liver and heart allogeneic transplants:
- Initially PO 7-9mg/kg/day PO divided BD
- Give 1st dose 4-12h pre-transplant
- Post-op: 1-2 weeks after
- Used in combination with azathioprine and corticosteroids
- Severe rheumatoid arthritis:
- PO Initially 1.5mg/kg BD, increased if necessary up to 2.5mg/kg BD after 6 weeks
- Increase 0.5-0.75mg/kg/day after 8 weeks and after 12weeks
- Max: 4mg/kg/day
- May be used alone or with methotrexate
- Discontinue if no benefit after 16 weeks
- Severe recalcitrant plaque psoriasis where conventional therapy ineffective or inappropriate:
- Initially 1.25mg/kg BD (max. per dose 2.5 mg/kg BD)
- Increased gradually to maximum if no improvement within 1 month
- Initial dose of 2.5mg/kg BD justified if condition requires rapid improvement
- Decrease dose by 25-50% at any time to control adverse effects
- Discontinue if inadequate response after 3 months at the optimum dose
- Maximum duration of treatment usually 1 year unless other treatments cannot be used
- Nephritic syndrome:
- PO 5mg/kg daily in 2 divided doses
- Maintenance: reduce to lowest effective dose according to proteinuria and serum creatinine measurements
- Discontinue after 3 months if no improvement in glomerulonephritis or glomerulosclerosis (after 6 months in membranous glomerulonephritis)
- Capsule:
- 50mg
- 100mg
- Taken without regards to meals
- Should NOT switch between different brands without close monitoring
Calcineurin inhibitor
It inhibits the production and release of lymphokines therefore suppressing cell-mediated immune response (mainly T-cells)
- Elevated BUN/Cr
- Hypertension
- Hirsutism
- Infection
- Tremor
- Gingival overgrowth
- Headache
- Hypertriglyceridemia (psoriasis use)
- Nausea & vomiting
- Diarrhea
- Leg Cramps
- Paresthesia
- Influenza-like symptoms
- Edema
- Dizziness
- Rash
- Acne
- Chest pain
- Stomatitis
- Hypomagnesemia
- Arthralgia
- Flushing
- Bronchospasm
- Hyperkalemia
- Hyperglycemia
- Hyperuricemia
- Hypersensitivity
- Breastfeeding
- Excessive sunlight exposure
- (RA/Psoriasis use): Abnormal renal function, uncontrolled hypertension, malignancies
- (Psoriasis use) Concomitant PUVA, UVB radiation, coal tar, methotrexate, other immunosuppressant use
WARNING:
- Only administered by experienced clinicians in the field of immunosuppresion
- Risk of infection and neoplasia in co-administration with other immunosuppressants in kidney, liver, and heart transplant recipients
- Live bacterial vaccines
- Bosentan
- Cidofovir
- Colchicine
- Dronedarone
- Elagolix
- Pimozide
- Eliglustat
- Flibanserin
- Grazoprevir
- Lomitapide
- Lonafarnib
- Mifepristone
- Pitavastatin
- Simvastatin
Drug Status
| Availability | Prescription only |
| Pregnancy | Category C |
| Breastfeeding | Contraindicated |
| Schedule | Not controlled |
| BRAND NAME | STRENGTH | FORMULATION | PACK SIZE | MANUFACTURER | DISTRIBUTOR |
|---|---|---|---|---|---|
| Arpimune ME | 25mg | Capsule | 50’s | RPG Life Sciences | Pharma Specialities |
| Arpimune ME | 50mg | Capsule | 50’s | RPG Life Sciences | Pharma Specialities |
| Arpimune ME | 100mg | Capsule | 50’s | RPG Life Sciences | Pharma Specialities |
| Panimun Bioral | 25mg | Capsule | 30’s | Panacea Biotec | Europa Healthcare |
| Panimun Bioral | 50mg | Capsule | 30’s | Panacea Biotec | Europa Healthcare |
| Panimun Bioral | 100mg | Capsule | 30’s | Panacea Biotec | Europa Healthcare |
| Sandimmun Neoral | 100mg | Capsule | 50’s | Novartis Pharma | Novartis Kenya |
| Sandimmun Neoral | 25mg | Capsule | 50’s | Novartis Kenya | Novartis Kenya |