Post Date April, 15 2023
Cyclosporine A is often used in the treatment of kidney disease, but the treatment with cyclosporine A alone has a high recurrence rate, so combination medication is often used. Cyclosporine A is often used in combination with the following three methods. Before use, it is necessary to conduct a test on the dosage and concentration of cyclosporine A to accurately administer medication.
1. Determination of cyclosporine A dosage
1) When treating nephrotic syndrome with cyclosporine A, the initial dose for adults is generally 4-5 mg/kg/d. The initial dose for children is 150 mg/m2/d, and the maximum dose does not exceed 200 mg/m2/d. For patients with abnormal SCr before treatment, if deemed necessary, the initial treatment dose should be 2.5 mg/kg/d or less. When using cyclosporine A, if the SCR increases by 30% compared to the base value, a reduction should be considered (0.5 to 1.0 mg/kg/d for each adjustment).
2) Comprehensive consideration should be given to the use of two parameters, drug dose and blood concentration, to guide dose adjustment. When adults are 5mg/d/d, and children are 200mg/m2/d, even if the blood concentration is low, increasing the dose of cyclosporine A will increase toxicity. The possibility of renal toxicity cannot be ruled out if the blood concentration of cyclosporine A is within the normal range.
3) When using csA, blood cholesterol should be adjusted to be below 6.5 mmol/L. When cholesterol levels are normal, the dosage of cyclosporine A is 4-5 mg/kg/d, and when blood cholesterol is 7.8 mmol/L, it is difficult to achieve effective tissue concentration.
4) The treatment course of cyclosporine A for nephrotic syndrome is 3-6 months, and a small dose (≤ 3mg/kg/d) of cyclosporine A can be used for long-term maintenance in a few patients. When cyclosporine A is used for nephrotic syndrome, there may be post-treatment effects (effects that occur after drug withdrawal or reduction).
2. Treatment of renal disease with combination medication
Due to the high recurrence rate after treatment with cyclosporine A alone, combined medication is often required in clinical practice. Combined use with adrenocortical hormones or other immunosuppressants can improve the clinical efficacy of cyclosporine A.
1) Combined use with adrenocortical hormone can increase sensitivity to treatment even in small doses (typically prednisone 0.5 mg/kg/d, adult 30 mg/d).
2) Cyclosporine A can also be used in combination with other immunosuppressants, but it is necessary to reduce the dose of other immunosuppressants and closely observe adverse reactions.
3) Cyclosporine A is safe to use in combination with low dose statins. Certain drugs such as erythromycin and a new generation of dihydropyridine calcium antagonists can increase the concentration of cyclosporin A. Although calcium antagonists can increase the concentration of cyclosporine A, they will not increase the nephrotoxicity of cyclosporine A, and can reduce the dosage of cyclosporine A.
