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Cyclosporine

Cyclosporine (Sandimmune«) is useful in the treatment of recalcitrant plaque psoriasis vulgaris, pustular psoriasis, severe lichen planus, pyoderma gangrenosum, and other responsive skin conditions.

Contraindications:

  • Reduced renal function
  • Uncontrolled hypertension
  • Malignancy (except nonmelanoma skin cancer)

Precautions:

  • Pretreatment assessment must include renal function and blood pressure.
  • Avoid, if possible, in pregnancy.
  • Safety in preadolescent children has not been established.
  • Nephrotoxicity is the major potential side effect. Pretreatment creatinine is necessary. Creatinine levels are repeated every 2 weeks for the first 3 months of therapy.
  • Hypertension is common. Pretreatment BP is measured, and the BP is assessed every 2 weeks while on treatment. Should hypertension occur, a reduction in dosage is indicated plus, if needed, calcium channel blockers. Beta blockers can exacerbate psoriasis.
  • There is probably an increased risk of skin cancer.
  • Ultraviolet light should be avoided during therapy.
  • Increased serum levels are caused by the concomitant use of ketoconazole, erythromycin, and oral contraceptives, among other drugs (see your compendium).

Adverse effects:

  • Renal dysfunction
  • Hypertension
  • Hypertrichosis
  • Paresthesia
  • Flu-like symptoms
  • Fatigue
  • Others (see your compendium).

Dosage:

  • 2.5 mg/kg/day in 2 divided oral doses.
  • Except in exceptional circumstances, total daily dosage should not exceed 5 mg/kg.
  • Stop if not improving after 6 weeks at this dosage.
  • An attempt should be made to find the lowest effective dose.


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