Immunosuppressants thrombocytopenia

Sirolimus is a potent immunosuppressive agent. To prevent thrombocytopenia and hypercholesterolemia, optimize efficacy, and reduce organ rejection, assays were developed to monitor concentrations of sirolimus in the whole blood of patients under treatment.40"12 Wallemacq et al.43 developed and validated a simple high-throughput HPLC-MS/MS method to routinely monitor sirolimus... 

Mercaptopurine [6-MP] (Purinethol) [Antineoplastic/ Antimeta lite] Uses Acute leukemias, 2nd-line Rx of CML NHL, maint ALL in children, immunosuppressant w/ autoimmune Dzs (Crohn Dz) Action Antimetabolite, mimics hypoxanthine Dose Adults. 80-100 mg/mVd or 2.5-5 mg/kg/d maint 1.5-2.5 mg/kg/d Peds. Per protocol X w/ renal/hepatic insuff on empty stomach Caution [D, ] Contra Severe hepatic Dz, BM suppression, PRG Disp Tabs SE Mild hematotox, mucositis, stomatitis, D rash, fever, eosinophilia, jaundice. Hep Interactions T Effects W/ allopurinol T risk of BM suppression W/ trimethoprim-sulfamethoxazole X effects OF warfarin EMS May falsely T glucose OD May cause NA and liver necrosis symptomatic and supportive Meropenem (Merrem) [Antibiotic/Carbapenem] Uses lntra-abd Infxns, bacterial meningitis Action Carbapenem X cell wall synth, a [3-lactam Dose Adults. 1 to 2 g IV q8h Peds. >3 mo, <50 kg 10-40 mg/kg IV q 8h in renal insuff Caution [B, ] Contra [3-Lactam sensitivity Disp Inj 500 mg, 1 g SE Less Sz potential than imipenem D, thrombocytopenia Interactions T Effects W/ probenecid EMS Monitor for signs of electrolyte disturbances and... 

Although corticosteroids possess immunosuppressive properties, their real value is in controlling the inflammation that can accompany transplantation and autoimmune disorders. Virtually all phases of the inflammatory process are affected by these drugs. Corticosteroid therapy alone is successful in only a limited number of autoimmune diseases, such as idiopathic thrombocytopenia, hemolytic anemia, and polymyalgia rheumatica. 

Azathioprine is a cytotoxic inhibitor of purine synthesis effective for the control of tissue rejection in organ transplantation. It is also used in the treatment of autoimmune diseases. Its biologically active metabolite, mercaptopurine, is an inhibitor of DNA synthesis. Mercaptopurine undergoes further metabolism to the active antitumour and immunosuppressive thioinosinic acid. This inhibits the conversion of purines to the corresponding phosphoribosyl-5 phosphates and hypoxanthine to inosinic acid, leading to inhibition of cell division and this is the mechanism of the immunosuppression by azathioprine and mercaptopurine. Humans are more sensitive than other species to the toxic effects of the thiopurines, in particular those involving the haematopoietic system. The major limiting toxicity of the thiopurines is bone marrow suppression, with leucopenia and thrombocytopenia. Liver toxicity is another common toxic effect. 

Warnings Should be administered in facilities equipped and staffed with adequate laboratory and supportive medical resources Immunosuppressive activity may vary from lot to lot Potential for the transmission of infectious agents Treatment should be discontinued if the following occur Symptoms of anaphylaxis Thrombocytopenia Leukopenia... 

Special Precautions Risk of infection, leukopenia, and thrombocytopenia Safety and effectiveness demonstrated only in patients who received concomitant immunosuppression Pregnancy Category C... 

Pneumococcal Vaccine, Polyvalent (Pneumovax-23) [Vaccine/ Inactive Bacteria] Uses immunization against pneumococcal Infxns in pts at high risk (eg, all = 65 y of age) Action Active immunization Dose 0.5 mL EM. Caution [C, ] Contra Do not vaccinate during immunosuppressive therapy Disp Inj SE Fever, inj site Rxn, hemolytic anemia, thrombocytopenia, anaphylaxis Interactions X- Effects W/ corticosteroids, immunosuppressants EMS None OD Unlikely... 

Efalizumab is administered weekly by subcutaneous injections to treat psoriasis, where a steady state is reached after 4 weeks. Its side effects include serious infections, thrombocytopenia, hemolytic anemia and the probability of malignancies due to its immunosuppressive effects. Other common side effects produced by efalizumab within 2 weeks of administration are nausea, fever, chills and headache. Furthermore, it can produce symptoms associated with hypersensitivity reaction. 

Hematologic disorders Immunosuppression Autoimmune hemolytic anemia, congenital hypoplastic anemia, erythroblastopenia, thrombocytopenia... 

Adverse Effects. Cyclophosphamide is used very cautiously as an immunosuppressant because of the possibility of severe side effects, including carcinogenic effects during long-term use. Other side effects include hematologic disorders (leukopenia, thrombocytopenia), cardiotoxicity, nephrotoxicity, and pulmonary toxicity. 

Hematological Anemia, leukopenia, thrombocytopenia, tumor lysis syndrome, immunosuppression... 

Diseases in which immunosuppression may be useful include tissue transplantation, inflammatory bowel disease, rheumatoid arthritis, chronic active hepatitis, systemic lupus erythematosus, glomerulonephritis, nephrotic syndrome, some haemolytic anaemias and thrombocytopenias, uveitis, myasthenia gravis, polyarteritis, polymyositis, systemic sclerosis, Behcet s syndrome. 

Thrombocytosis is another common hematologic finding with active rheumatoid arthritis. Platelet counts rise and fall in direct correlation with disease activity in many patients. Thrombocytopenia may result from toxicity of gold salts, penicillamine, or immunosuppressive therapy. Thrombocytopenia also may be observed in Felty s syndrome or vascuhtis. 

Commonly reported adverse effects of mycophenolate mofetil include gastrointestinal toxicity (diarrhea, nausea, and vomiting), hematologic effects (anemia, neutropenia, and thrombocytopenia), and an increased incidence of viral and bacterial infections. Lym-phoproliferative disease or lymphoma has developed in up to 1 % of patients who received mycophenolic acid with other immunosuppressive agents. 

If no functional impairment is present, patients with fimited disease are not treated with systemic therapy. A variety of topical preparations may be used in patients with skin-only disease, snch as clo-betasol, tacrolimus, and pimecrofimus. Many patients with extensive chronic GVHD, if left untreated, will die of infections or become disabled. The long-term survival rate is worse in certain snbgronps of patients, such as patients with extensive skin involvement, thrombocytopenia, progressive onset of chronic GVHD, and those who fail to respond to immunosuppressive therapy. 

Trimethoprim (and pyrimethamine) may cause anemia, leukopenia, and thrombocytopenia, most commonly in debilitated or immunosuppressed patients. Hematotoxicity, drug fever, rashes, and severe GI distress are problematic in patients with AIDS. 

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