Drug | Dosing | Side Effects |
---|---|---|
Calcineurin inhibitors | ||
Cyclosporine | 4-8 mg/kg/day in 2 divided doses, titrated to keep target 12-hour trough levels | Renal insufficiencyHypertension and dyslipidemia |
Hypokalemia and hypomagnesemia | ||
Hyperuricemia | ||
Neurotoxicity (encephalopathy, seizures, tremors, neuropathy) | ||
Gingival hyperplasia | ||
Hirsutism | ||
Tacrolimus | 0.05-0.1 mg/kg/day in 2 divided doses, titrated to keep target 12-hour trough levels | Renal dysfunctionHypertensionHyperglycemia and diabetes mellitus |
Dyslipidemia | ||
Hyperkalemia | ||
Hypomagnesemia | ||
Neurotoxicity (tremors, headaches) | ||
Cell cycle agents | ||
Azathioprine | 1.5-3.0 mg/kg/day, titrated to maintain white blood cell level at approximately 3K | Bone marrow suppressionHepatitis (rare) |
Pancreatitis | ||
Malignancy | ||
Mycophenolate mofetil | 2,000-3,000 mg/day in 2 divided doses | Gastrointestinal (nausea, gastritis, diarrhea)Leukopenia |
Proliferation signal inhibitors | ||
Sirolimus | 1-3 mg/day, titrated to keep therapeutic 24-hour trough levels | Oral ulcerationsHypercholesterolemia and hypertriglyceridemia |
Poor wound healing | ||
Lower extremity edema | ||
Pulmonary toxicities (pneumonitis, alveolar hemorrhage) | ||
Leukopenia, anemia, and thrombocytopenia | ||
Pericardial effusion | ||
Potentiation of calcineurin inhibitor nephrotoxicity | ||
Everolimus | 1.5 mg/day in 2 divided doses | Oral ulcerations |
Hypercholesterolemia and hypertriglyceridemia | ||
Poor wound healing | ||
Lower extremity edema | ||
Pulmonary toxicities (pneumonitis, alveolar hemorrhage) | ||
Leukopenia, anemia, and thrombocytopenia | ||
Potentiation of calcineurin inhibitor nephrotoxicity | ||
Corticosteroids | ||
Prednisone | 1 mg/kg/day in 2 divided doses, tapered to 0.05 mg/kg/day by 6-12 months | Weight gainHypertension, hyperlipidemia, hyperglycemia |
Osteopenia | ||
Poor wound healing | ||
Salt and water retention | ||
Proximal myopathy | ||
Cataracts | ||
Peptic ulcer disease |