UMEM Educational Pearls

Title: Transplant Med Toxicology

Keywords: transplant, tacrolimus, sirolimus, cyclosporine (PubMed Search)

Posted: 2/9/2010 by Bryan Hayes, PharmD (Updated: 2/11/2010)
Click here to contact Bryan Hayes, PharmD

With all of the post-transplant patients we see in the ED, a refresher on the toxicities associated with the most common immunosuppressant medications is warranted.

Cyclosporine (Sandimmune^® and Neoral^®/Gengraf^®) and tacrolimus (Prograf^®) are both calcineurin inhibitors that inhibit activation and proliferation of T-lymphocytes and IL-2.

- Major concerns: Nephrotoxicity, drug interactions (CYP3A4)

- Adverse Effects:

o Electrolyte abnormalities: K+, ¯Mg+, glucose

o CNS: HA, tremor (statistically higher with tacrolimus)

o CV: HTN, lipids (increased with cyclosporine)

o End organ: hepatotoxicity, nephrotoxicity

o Cosmetic (cyclosporine specific): hirsutism, gingival hyperplasia, acne

Sirolimus/Rapamycin (Rapamune^®) is an M-tor inhibitor that inhibits T-lymphocyte activation and proliferation.

- Major concerns: Drug interactions (CYP3A4)

- Adverse Effects:

o Delayed wound healing

o Leucopenia, thrombocytopenia

o Hypercholesterolemia