Cyclosporine A



  • Anti-Rejection Agent for Solid Organ Transplant




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  • PO: 5 mg/kg/day
    • Monitor: CSA level

Dose Adjustment

  • Hepatic
  • Renal

Adverse Effects

Endocrinologic Adverse Effects

Drug-Induced Hyporeninemic Hypoaldosteronism (see Hypoaldosteronism, [[Hypoaldosteronism]])

  • Physiology: drug-induced hypoaldosteronism
    • Decreased renin release -> decreased secretion of aldosterone (i.e. hyporeninemic hypoaldosteronism) -> inhibition of potassium secretion in the renal collecting duct
    • Decreased responsiveness to aldosterone (likely due to decreased mineralocorticoid receptor expression) -> inhibition of potassium secretion in the renal collecting duct

Gastrointestinal Adverse Effects

Acute Pancreatitis (see Acute Pancreatitis, [[Acute Pancreatitis]])

  • Epidemiology: questionable association

Neurologic Adverse Effects

Posterior Reversible Encephalopathy Syndrome (PRES) (see Posterior Reversible Encephalopathy Syndrome, [[Posterior Reversible Encephalopathy Syndrome]])

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Pulmonary Adverse Effects

Diffuse Alveolar Hemorrhage (see Diffuse Alveolar Hemorrhage, [[Diffuse Alveolar Hemorrhage]])

  • Diagnosis: absence of pulmonary capillaritis
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Renal Adverse Effects

Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]])

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Hyperkalemia (see Hyperkalemia, [[Hyperkalemia]])

  • Epidemiology : hyperkalemia occurs in 44-73% of transplant patients who receive cyclosporine A or tacrolimus [MEDLINE]
  • Physiology: drug-induced hyporeninemic hypoaldosteronism (see above)
  • Treatment: fludrocortisone may be effective

Type 4 Renal Tubular Acidosis (RTA) (see Type 4 Renal Tubular Acidosis, [[Type 4 Renal Tubular Acidosis]])

  • Physiology: drug-induced hyporeninemic hypoaldosteronism (see above)

Other Adverse Effects

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  • Frequency of hyperkalemia in recipients of simultaneous pancreas and kidney transplants with bladder drainage. Transplantation 1996;62: 1174-5 [MEDLINE]
  • Renal function and blood pressure in patients receiving long-term, low-dose cyclosporine therapy for idiopathic autoimmune uveitis. Ann Intern Med. 1992;117:578–583
  • Studies to determine the basis for hyperkalemia in recipients of a renal transplant who are treated with cyclosporine. J Am Soc Nephrol. 1992;2:1279–1284