stanford school of medicine logotitle logo
advanced

 

 

Cardiology

 

Endocrinology

 

Gastroenterology

 

General Inpatient Medicine

 

Hematology

 

Infectious Disease

 

Nephrology

 

Neurology

 

Oncology

 

Outpatient & Preventative Medicine

 

Palliative Care

 

Psychiatry

 

Pulmonary/Critical Care

 

Rheumatology

Transplant Immunosuppressants - Common Side Effects

Transplant Immunosuppressants
1.  Calcineurin Inhibitors (Tacrolimus, aka Prograf, and Cyclosporine)  – bind to intracellular recepts and inactivate calcineurin, which inhibits IL-2 production and ultimately blocks T-cell synthesis. 
Side effects:

  • Renal toxicity – both acute and chronic.  Acutely, due to dose-related vasoconstriction, and also associated with multiple electrolyte abnormalities (hyperkalemia, hypermagnesemia, etc).  Chronically, due to tubular atrophy, endothelial damage, glomerular ischemia, interstitial fibrosis, and long-term HTN and diabetes.  Chronic calcineurin inhibitor use is a major contributor to chronic kidney disease in these patients.
  • Neuro-toxicity – tremor, headache, seizures, paresthesias, and PRES.
  • Hypertension 
  • Metabolic effects – Diabetes, Obesity.
  • Cyclosporine also tends to cause hirsutism and gingival hyperplasia.

 

 

2.  MMF (Mycophenolate, aka Cellcept) – inhibits inosine monophosphate dehydrogenase and blocks guanine synthesis, inhibiting T and B cell proliferation.
Side effects:

  • Bone marrow suppression
  • GI side effects – dyspepsia, peptic ulcer disease, and diarrhea

 

 

3.  Rapamycin (Sirolimus) – also inhibits IL-2 signaling, but in a different pathway than calcineurin inhibitors – they can be synergistic together! 
Side effects:

  • Bone marrow suppression
  • Hyperlipidemia
  • Impaired Wound Healing – big problem, especially after big operations to perform the transplant!

 

 

(Chanu Rhee MD, 6/3/11)