Methotrexate Ciclosporin

CICLOSPORIN METHOTREXATE t risk of renal toxicity and renal failure Additive renal toxicity Monitor renal fundion prior to and during therapy, and ensure and intake of at least 2 L of fluid daily. Monitor serum potassium and magnesium and corred any deficiencies... 

Ciclosporin, a calcineurin inhibitor, is a potent immunosuppressant useful in the prevention of rejection in organ transplants and grafting procedures. Ciclosporin is markedly nephrotoxic. Vincristine is a vinca alkaloid cytotoxic agent fluorouracil and methotrexate are both antimetabolite cytotoxic agents and bleomycin is a cytotoxic antibiotic. 

Astralagus 2. Echinacea 3. Liquorice 4. Milk thistle 5. Neem 6. Sea buckthorn 1. Ciclosporin 2. Azathioprine 3. Methotrexate 4. Tacrolimus 5. Dadizumab 6. Cyclophosphamide Possibility of graft rejection 1 blood level unknown mechanism (astralagus). Other mechanisms alkyl amides from echinacea modulate tumour necrosis factor alpha mRNA expression in human monocytes/macrophages via the cannabinoid type 2 receptor Unknown mechanism (milk thistle is known to l cyclosporine levels neem L effects of azathioprine, prednisolone and dadizumab sea buckthorn may 1 effect of cyclophosphamide) Induces metabolizing enzymes, CYP3A4 and P-gp (St John s wort L ciclosporin and tacrolimus levels) Avoid concomitant use of the herb... 

These include mesalazine, metformin, NSAIDs, tetracyclines (except doxycycline and minocycline), chloramphenicol, lithium, methotrexate, chloroquine, fibrates, chlorpropamide and glibenclamide, Clinically, it is useful to measure urine output per hour or per 24 hours as a fall in urine output in the presence of adequate fluid intake often indicates or warns of some impairment of renal function. Furthermore, it is neither expensive nor time-consuming to perform a quick test for albumin, casts and red cells in the urine, and to measure pH. Creatinine clearance values are often used to determine the safe doses for several drugs (e.g. NSAIDs, ciclosporin). 

Folic acid antagonists, e.g. methotrexate, can also suppress epidermal activity temporarily, as does ciclosporin, but they are too toxic for use unless the psoriasis or associated arthritis is severely disabling and, preferably, the patients are past their reproductive years. 

High-dose chemotherapy with cyclophosphamide, vincristine, prednisolone, and intrathecal methotrexate given for post-transplant lymphoproliferative disease was suggested to have favored the occurrence of acute ciclosporin neurotoxicity (headache, fever, seizures, and visual agnosia) in a 9-year-old cardiac transplant patient (239). Ciclosporin serum concentrations were normal and a further similar episode occurred on ciclosporin readministration. 

A 36-year-old man with Crohn s disease became refractory to standard anti-inflammatory treatment (glucocorticoids, mercaptopurine, methotrexate, ciclosporin, tacrolimus) (33). Remission over 8 months was achieved with a single infusion of infliximab. With the onset of relapse he was given another infusion of infliximab and had an anaphylactic-Uke reaction within 1 minute. 

Immunosuppressants, such as azathioprine, ciclosporin and methotrexate, can be used to treat severe inflammatory disease. Their use depends on their ability to inhibit the activity and proliferation of lymphocytes and other leukocytes and because of this they are very toxic to the bone marrow. Other adverse effects are nausea, leukopenia, blurred vision, rashes and hair loss. 

Previous or concurrent treatment with methotrexate may possi-biy increase the risk of liver and other toxicity in those given ciciosporin, but effective and valuable concurrent use has also been reported. Ciclosporin causes a moderate rise in serum methotrexate levels, but methotrexate does not appear to affect the pharmacokinetics of ciclosporin. 

A pilot study deseribed the efifeetive use of eielosporin and methotrexate for the control of acute graft-versus-host disease in bone marrow transplant patients, with the ciclosporin dosage reduced by 50% to... 

A 43-year-old man used acitretin, phototherapy, methotrexate, ciclosporin, and infliximab and had an initially good response, but then relapsed. Etanercept 50 mg twice a week for 3 months, then 25 mg twice a week, was introduced, and after 14 months he noticed black lesions over injection sites, initially on the abdomen. He then carried out injections into the thigh, where the same reactions occurred. A biopsy of a black papule was consistent with angiokeratoma. 

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