Tacrolimus hypertension with

The incidence of hypertension and the prevalence of antihypertensive drug use are lower with tacrolimus than with ciclosporin (5,12). 

Taylor DO, Barr ML, Radovancevic B, Renlund DG, Mentzer RM, Jr., Smart FW,Tolman DE, Frazier OFI, Young JB,VanVeldhuisen P. A randomized, multicenter comparison of tacrolimus and cyclosporine immunosuppressive regimens in cardiac transplantation decreased hyperlipidemia and hypertension with tacrolimus. J Fleart Lung Transplant 1999 18 336-345. 

Clinical experience following kidney transplantation suggests that primary prophylaxis with tacrolimus results in 1-year graft and patient survival rates that are equivalent to those achieved with Cy A therapy, although with lower rates of acute rejection episodes.Five-year follow-up data suggest improved graft survival with tacrolimus compared with Cy A. Nephrotoxicity, hypertension, and posttransplant diabetes mellitus may occur and v/ere reported commonly in the early studies. ... 

The nephrotoxicity profile of tacrolimus is very similar to that of CsA. Tacrolimus induces acute and reversible functional changes in renal function, chronic renal irreversible structural injury, electrolyte disturbances, renal tubular acidosis and hemolytic-uremic syndrome. There are some few and important differences tacrolimus induces less hypertension but more glucose metabohsm impairment than CsA [242, 515-521]. Also resembling CsA, tacrolimus association with drugs that interfere with the cytochrome P-450 metabolism or with other nephrotoxic drugs, can precipitate acute renal dysfunction [522-526]. ... 

P. A randomized, multicenter comparison of tacrolimus and cyclosporine immunosuppressive regimens in cardiac transplantation decreased hyperlipidemia and hypertension with tacrolimus. J Heart Lung Transplant 1999 18 336-345. 

PRES is a syndrome that results from loss of cerebral autoregulation and capillary leakage in association with a variety of clinical entities including acute hypertension preeclampsia and eclampsia septic shock autoimmune diseases such as systemic lupus erythematosus and Wegener granulomatosis treatment with immunosuppressive agents snch as cyclosporin and tacrolimus treatment with chemotherapentic agents such as intrathecal... 

A retrospective study of 33 heart transplant patients on tacrolimus (TAC) with everolimus, adverse events included hyperlipaemia (48.5%), hypertension (33.3%) and diabetes mellitus (36.4%) [17 ]. 

Tacrolimus, an immunosuppressant that inhibits T-cell activation, is a useful alternative in severe recalcitrant psoriasis. Although it is not FDA approved for this indication, patients have received oral doses of 0.05 mg/kg daily, with increases up to 0.15 mg/kg daily, depending on results. Adverse effects include diarrhea, nausea, paresthesias, hypertension, tremor, and insomnia. 

Monitoring Regularly assess serum creatinine and potassium. Perform routine monitoring of metabolic and hematologic systems as clinically warranted. Hypertension Hypertension is a common adverse effect of tacrolimus therapy. Mild or moderate hypertension is reported more frequently than severe hypertension. Hyperglycemia Hyperglycemia was associated with the use of tacrolimus in 29% to... 

Hypertension is a common occurrence with tacrolimus and may require treatment with antihypertensive agents. Since tacrolimus may cause hyperkalemia, potassium-sparing diuretics should be avoided... 

The side effects associated with tacrolimus administration include nephro- and hepa-totoxicity, hypertension, tremors, seizures, diabetes mellitus, neuropathy, blurred vision, depression, loss of appetite andconfusion. Tacrolimus may cause opportunistic... 

Tacrolimus, an immunosuppressant that inhibits T-cell activation, is a useful alternative in severe recalcitrant psoriasis. Although it is not FDA approved for this indication, patients have received oral doses of 0.05 mg/kg daily, with increases up to 0.15 mg/kg daily, depending on results. Adverse effects include diarrhea, nausea, paresthesias, hypertension, tremor, and insomnia. Methotrexate, an antimetabolite, is indicated for moderate to severe psoriasis. It is particularly beneficial for psoriatic arthritis. It is also indicated for patients refractory to topical or UV therapy. Methotrexate can he administered orally, subcutaneously, or intramuscularly. The starting dose is 7.5 to 15 mg per week, increased incrementally by 2.5 mg every 2 to 4 weeks until response maximal doses are approximately 25 mg/wk. Adverse effects include nausea, vomiting, mucosal ulceration, stomatitis, malaise, headache, macrocytic anemia, and hepatic and pulmonary toxicity. Nausea and macrocytic anemia can be ameliorated by giving oral fohc acid 1 to 5 mg/day. Methotrexate should be avoided in patients with active infections and in those with liver disease. It is contraindicated in pregnancy because it is teratogenic. 

In 16 renal transplant patients with suspected ciclosporin nephrotoxicity, the addition of mycophenolate allowed safe reduction in the dosage of ciclosporin, with subsequent improvement in renal function and arterial blood pressure over 6 months (1). It might allow the rapid withdrawal of glucocorticoids in patients taking ciclosporin or tacrolimus, and therefore reduce the incidence of glucocorticoid-induced post-transplant diabetes, hypercholesterolemia, and hypertension (2). There have been several reports of patients with ciclosporin-associated thrombotic micro-angiopathy/hemolytic-uremic syndrome in whom mycophenolate was successfully substituted (3,4). 

In children one advantage of tacrohmus is that it can reduce the dose of glucocorticoids required for immunosuppression. This in turn improves growth. When in one center the immunosuppression protocol was changed to tacrolimus plus mycophenolate mofetU and prednisone, two patients developed transient encephalopathy associated with tacrolimus (35). In both cases, the encephalopathy was managed by treating the associated hypertension and fluid overload tacrolimus was not withdrawn. 

Adverse effects include diarrhea, nausea, paresthesias, hypertension, tremor, and insomnia. Other toxicities with topical tacrolimus— including renal insufficiency and immunosuppression—have been rarely reported. ... 

Nephrotoxicity, neurotoxicity (tremor, headache, motor disturbances, seizures), G1 complaints, hypertension, hyperkalemia, hyperglycemia, and diabetes are all associated with tacrolimus use. As with cyclosporine, nephrotoxicity is limiting. Tacrolimus has a negative effect on pancreatic islet beta cells, and glucose intolerance and diabetes melli-tus are well-recognized complications of tacrolimus-based immunosuppression. As with other immunosuppressive agents, there is an increased risk of secondary tumors and opportunistic infections. Notably, tacrolimus does not adversely affect uric acid or LDL cholesterol. 

Toxicity The principal adverse reactions to cyclosporine therapy are renal dysfunction, tremor, hirsutism, hypertension, hyperhpidemia, and gum hyperplasia. Hyperuricemia may lead to worsening of gout, increased P-glycoprotein activity, and hypercholesterolemia. Nephrotoxicity occurs in the majority of patients treated and is the major indication for cessation or modification of therapy. Hypertension occurs in -50% of renal transplant and almost all cardiac transplant patients. Combined use of calcineurin inhibitors and glucocorticoids is particularly diabetogenic, although this apparently is more problematic in patients treated with tacrohmus see below). Especially at risk are obese patients, African American or Hispanic recipients, or those with family history of type 2 diabetes or obesity. Cyclosporine, as opposed to tacrolimus, is more hkely to produce elevations in low-density lipoprotein (LDL) cholesterol. 

Nephrotoxicity, neurotoxicity (tremor, headache, motor disturbances, seizures), GI complaints, hypertension, hyperkalemia, hyperglycemia, and diabetes are all associated with tacrolimus use. 

Ciclosporin versus tacrolimus In a retrospective comparison of ciclosporin and tacrolimus in 100 liver transplant recipients who were followed for 12 months, the incidences of new-onset arterial hypertension and diabetes mellitus were not different [6 ]. However, there was a significantly higher incidence of hyperlipidemia in those who took ciclosporin, with a greater difference at 6 months than at 12 months. 

Systematic reviews In a systematic review of 10 randomized trials in 952 heart transplant recipients, a ciclosporin-based immunosuppressive regimen caused more hypertension, hyperlipidemia, gingival hyperplasia, and hirsutism than tacrolimus [7 ]. There were no significant differences with regard to acute rejection, diabetes mellitus, renal dysfunction, infection, malignancy, or neurotoxicity. 

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