Cyclosporine (Sandimmune®) is useful in the treatment of recalcitrant plaque psoriasis vulgaris, pustular psoriasis, severe lichen planus, pyoderma gangrenosum, and other responsive skin conditions.
- Reduced renal function
- Uncontrolled hypertension
- Malignancy (except nonmelanoma skin cancer)
- 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).
- Renal dysfunction
- Flu-like symptoms
- Others (see your compendium).
- 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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