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Sandimmun is an immunosuppressive drug, used to reduce the body's immune response. In the article below, I will share how to use and note when using Sandimmun most effectively.
1. Effects and indications of the drug Sandimmun
1.1. The effect of Cyclosporin In the drug Sandimmun contains the active ingredient Cyclosporin c is a cyclic polypeptide consisting of 11 amino acids, which has immunosuppressive effects through preventing the formation of cell-mediated immune responses. , while inhibiting the production and release of Lymphokines. Cyclosporin specifically affects lymphocytes and phagocytic function and does not affect hematopoiesis, reducing the risk of infection compared with other immunosuppressants.
1.2. What are the main uses of Sandimmun? Sandimmun is used in the following cases:
Prevention of rejection of kidney, liver, heart - lung and pancreas transplants. Prophylaxis of rejection after bone marrow transplantation and rejection reactions. Treatment of severe rheumatoid arthritis in poor response to methotrexate. Methotrexate can be used in combination with cyclosporin for patients with rheumatoid arthritis that does not improve with methotrexate alone. Treatment of widespread plaque psoriasis with disabling consequences that is difficult to treat. Treatment of nephrotic syndrome in patients with glomerular disease.
2. How to use Sandimmun
2.1. Dosage Prophylaxis of transplant rejection: Usual starting oral dose:
10 - 15mg Ciclosporine/kg, orally once, 4 - 12 hours before transplantation. Next, 10 - 15 mg of ciclosporine/kg/day for 1-2 weeks after surgery, then 5% weekly to maintenance dose of 2 - 6 mg of ciclosporine/kg/day (blood levels should be monitored and controlled Check renal function to adjust dose accordingly) Ciclosporine dose will be lower if used concomitantly with other immunosuppressive drugs such as corticosteroids. In patients who are intolerant of oral cyclosporin, a dose of 1/3 of the oral dose can be infused intravenously, slowly over 2-6 hours or longer; The drug is diluted with 0.9% sodium chloride solution or 5% glucose solution, from 5% to a solution of 0.05 - 0.25%. To prevent possible anaphylactic reactions when taking Sandimmun, the patient can be switched to oral administration as soon as possible. Prophylaxis and treatment of rejection in bone marrow transplantation:
Initial dose intravenously 3 - 5 mg Ciclosporine/kg/day, 1 day before transplantation, then continue up to 2 weeks, then gradually switch to oral 12.5 mg Ciclosporine/kg/day for 3-6 months, then gradually reduce oral dose, can be used for up to one year after transplantation (or at the beginning of oral administration, dose 12.5 - 15 mg ciclosporine/kg/day) . In the case of lung transplantation, Cyclosporin is also inhaled. Treatment of psoriasis:
Oral dose: Initially 2.5mg Ciclosporine/kg/day. A maximum of 4 mg of Ciclosporine. Cyclosporin dose is gradually reduced to the lowest effective dose. If there is a lack of response to the maximum dose within 6 weeks, treatment should be discontinued. Rheumatoid Arthritis:
The starting oral dose is 2.5mg Ciclosporine/kg/day, divided into 2 divided doses, for 6 or 8 weeks. If clinical response is inadequate, the dose may be increased gradually up to a maximum of 4 mg ciclosporine/day. If there is no response after 3-4 months of treatment with Cyclosporin, treatment must be discontinued. Nephrotic syndrome due to glomerular disease : Recommended oral dose divided into 2 times a day:
In adults 5 mg Ciclosporine/kg/day. In children 6 mg ciclosporine/kg/day when renal function is normal, except for proteinuria. If renal impairment is present, the initial dose is ≤ 2.5 mg ciclosporine/kg/day. The dose of Cyclosporin should be adjusted according to the individual patient, depending on serum creatinine and proteinuria, but should never exceed the recommended dose of Cyclosporin. Maintenance dose: tapered to the lowest effective dose. If after 3 months of treatment with Cyclosporin there is no effect, the drug must be stopped. The above is only the dose of Sandimmun for reference. Patients need to follow the instructions for use of the doctor or pharmacist in all cases to achieve optimal treatment effect.
2.2. How to use Patients should be monitored Cyclosporin blood or plasma concentrations to determine the dose.
Cyclosporin must be taken with meals and taken at a fixed time of the day. Note, Sandimmun can be mixed with milk or fruit juice, except grapefruit juice, right before drinking to make it easier to drink and avoid vomiting.
3. Contraindications to the use of Sandimmun
Sandimmun medicine is not used in the following cases:
Patients with a history of allergy, hypersensitivity to Cyclosporin or hypersensitivity to any substance in the composition of the product. Sandimmun should not be used in patients with psoriasis or rheumatoid arthritis whose kidney function is not normal.
4. What side effects does Sandimmun cause when used?
During the use of Sandimmun, patients may experience some unwanted side effects that are reported statistically as follows:
Headache, allergic reaction, fatigue, rash, feeling hot flashes in limbs, convulsions, electrolyte disturbances, hyperkalemia, hirsutism, edema... Toxic to the kidneys. Hypertension . Hairy, fish eggs. Abdominal discomfort, mild gastrointestinal disturbances, nausea, vomiting. Tremor, muscle weakness, leg muscle spasticity (neuro-musculoskeletal). Flushing, feeling warm, fast heart rate. Hyperkalemia, hyperuricemia, hypomagnesemia. Pancreatitis Hepatotoxicity Myositis, paresthesias. Respiratory failure Sinusitis Anaphylaxis, sensitivity to too high or too low temperatures, increased risk of bacterial infection.
5. Sandimmun drug interactions
Sandimmun may interact with some other drugs causing increased toxicity, increased side effects, decreased or lost activity.
Some drugs that appear to interact with Sandimmun should be noted when taking together:
Diuretics. Allopurinol. Acyclovir. NSAIDs. Beta blockers. Vancomycin. Barbiturates. Chloroquine antibiotic. Rifampicin. Carbamazepine, Phenytoi., Phenobarbital. Rifampin, Isoniazid; Clarithromycin. Nicardipine, Diltiazem, Verapamil. Itraconazole, Fluconazole, Ketoconazole. Erythromycin, Amphotericin B, Aminoglycoside, Acyclovir. To ensure the safety of using Sandimmun, patients should provide full information about the names of drugs or health protection products they are using to their doctor or pharmacist before using the drug.
6. Note when using and storing Sandimmun
Caution should be exercised when using Sandimmun in the following subjects:
Sandimmun should be used with caution in children because there are no comprehensive studies on efficacy and safety. Patients with high uric acid levels in the blood. Patients with impaired liver function and kidney failure. In the process of taking the drug, it is necessary to pay attention to monitoring liver and kidney function, blood pressure, levels of potassium, magnesium, uric acid in the blood, ... Patients should not arbitrarily use Cyclosporin but should follow the instructions of the doctor. , pharmacist. Use Cyclosporin with caution while driving or operating machinery. There are no reports of safety when using Cyclosporin in pregnant women and nursing mothers. Users should store Sandimmun medicine in a cool, non-humid place, temperature < 30 degrees Celsius. Sandimmun should not be stored in the freezer compartment of the refrigerator or places with high humidity such as the bathroom. Limit all impacts from direct sunlight on the product. Keep Sandimmun medicine out of reach of small children and household pets.
7. What to do when overdose, forget dose of Sandimmun?
7.1. Overdose Cases Symptoms
Patients with an overdose of Sandimmun may experience some transient toxic effects on the liver and kidneys, which may resolve after elimination or discontinuation of Sandimmun. Treatment
When acute oral Cyclosporin overdose, the method used is gastric lavage and gastric emptying by induction of vomiting. The emetic method is only useful until 2 hours after taking Sandimmun . If the patient is comatose, has lost pharyngeal reflexes, or has a seizure, gastric lavage can be performed if means are available to prevent the patient from aspiration of gastric waste. There is no antidote to the drug Sandimmun conducts resuscitation and symptomatic treatment. Hemodialysis is not effective in eliminating Cyclosporin. Therefore, when a Cyclosporin overdose/emergency occurs, the patient should stop taking the drug for a few days or start treatment with Cyclosporin every other day until the patient is stable. 7.2. Missed dose If a dose of Sandimmun is forgotten, take it as soon as you remember. However, if the missed dose of Sandimmun is close to the next dose. Skip the missed dose and take your next dose at the scheduled dosing time. Do not take a double dose of Sandimmun to make up for a missed dose.
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