Gastrointestinal immunosuppression

Ciclosporin is a potent immunosuppressant, which is markedly nephrotoxic. It may cause gastrointestinal disturbances. Ciclosporin is available as capsules, oral solution and parenteral preparations. 

Ribavirin (Tribavirin) is a synthetic nucleoside which may be administered by inhalation via a special ventilator for RSV bronchiolitis in infants and children. Efficacy for this indication is controversial, and it is usually reserved for the most severe cases, and those with co-existing illnesses, such as immunosuppression. Systemic absorption by the inhalational route is negligible. It is effective by mouth 45 h) in treating Lassa fever and, when combined with interferon alfa-2b, for chronic hepatitis C infection (see below). Systemic ribavirin is an important teratogen, and it may cause cardiac, haematological, gastrointestinal and neurological side effects. 

Adverse effects usually occur during the first two months of treatment, do not correlate with the daily dose, and result in treatment withdrawal in 14—18% of patients, mainly because of bone marrow suppression, gastrointestinal symptoms, hypersensitivity reactions, and infections (1-3). Immediate or long-term adverse effects are of particular concern outside the field of immunosuppression where other treatment options are frequently available, but in any field of use the adverse effects of these drugs weigh heavily. 

Gusperimus is a guanidine derivative with antitumor and immunosuppressive properties. Its mechanism of action is not well understood and may involve blockade of the maturation of B and T lymphocytes and monocytes, with inhibition of both cell-mediated and antibody-mediated immunity. In preliminary clinical trials in transplant patients, adverse effects at low doses included mild-to-moderate leukopenia, facial and perioral numbness, anorexia, gastrointestinal disturbances, facial flushing. 

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