Switching between cyclosporin formulations. What are the risks?

Ali J. Olyaei, Angelo M DeMattos, William M. Bennett

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

The introduction of cyclosporin, refinement in surgical techniques and improvement in allograft preservation have all led to an improvement in graft and ultimately patient survival. Cyclosporin is a lipophilic cyclic polypeptide produced by Trichoderma, a fungus isolated from Norwegian soil. Cyclosporin is a potent, selective and powerful immunosuppressive agent possessing a narrow therapeutic window. Substitution among different formulations of cyclosporin for economic reasons, without close monitoring of pharmacokinetics and pharmacodynamics, can induce undesirable toxic effects. A number of recent reports, largely anecdotal, of adverse drug reactions and acute cellular rejection after conversion from the standard formulation to the microemulsion formulation of cyclosporin have created uncertainty over the therapeutic equivalency of these agents. This leading article reviews the pharmacology, pharmacokinetics and adverse drug reactions of cyclosporin as well as the potential risks associated with switching between cyclosporin formulations in stable renal transplant recipients. Caution should be employed when switching between cyclosporin formulations. Since data are limited, long-term prospective studies are necessary to delineate the role of high peak concentrations obtained from the microemulsion formulation in relation to cyclosporin-induced chronic nephropathy. The significance of the reduction in pharmacokinetic variability with use of the microemulsion formulation in terms of graft and patient survival remains unclear.

Original languageEnglish (US)
Pages (from-to)366-373
Number of pages8
JournalDrug Safety
Volume16
Issue number6
StatePublished - 1997
Externally publishedYes

Fingerprint

Cyclosporine
Pharmacokinetics
Microemulsions
Drug-Related Side Effects and Adverse Reactions
Grafts
Pharmacodynamics
Therapeutic Equivalency
Transplants
Trichoderma
Poisons
Graft Survival
Immunosuppressive Agents
Fungi
Pharmaceutical Preparations
Uncertainty
Allografts
Substitution reactions
Soil
Economics
Prospective Studies

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Pharmacology
  • Toxicology
  • Health, Toxicology and Mutagenesis

Cite this

Switching between cyclosporin formulations. What are the risks? / Olyaei, Ali J.; DeMattos, Angelo M; Bennett, William M.

In: Drug Safety, Vol. 16, No. 6, 1997, p. 366-373.

Research output: Contribution to journalArticle

Olyaei, AJ, DeMattos, AM & Bennett, WM 1997, 'Switching between cyclosporin formulations. What are the risks?', Drug Safety, vol. 16, no. 6, pp. 366-373.
Olyaei, Ali J. ; DeMattos, Angelo M ; Bennett, William M. / Switching between cyclosporin formulations. What are the risks?. In: Drug Safety. 1997 ; Vol. 16, No. 6. pp. 366-373.
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