Maintenance Immunosuppression Regimen17
| 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 | ||