multi class comparison
Immunosuppressant Comparison: Cyclosporine vs Tacrolimus vs Mycophenolate — Transplant Drug Monitoring
All three drugs prevent organ rejection, but the NCLEX expects you to match the right adverse effect to the right drug. Picking "nephrotoxicity" for mycophenolate or "myelosuppression" for cyclosporine loses you the question — and in practice, means you miss the lab value that signals toxicity.
Comparison
Side-by-side3 compared
Comparevs
Dimension
Cyclosporine
Tacrolimus
Mycophenolate
Class & mechanism
- Binds cyclophilin → ↓ calcineurin → ↓ IL-2
- Binds FKBP → ↓ calcineurin (more potent)
- ↓ Purine synthesis → ↓ lymphocyte proliferation
Indications
- Transplant rejection prophylaxis
- Transplant rejection prophylaxis
- Transplant rejection prophylaxis
Route & administration
- PO/IV; avoid grapefruit (CYP3A4)
- PO/IV; avoid grapefruit (CYP3A4)
- PO/IV; give on empty stomach
Key assessment
- Monitor for signs of infection
- Renal function (nephrotoxic)
- Monitor for signs of infection
- Renal function (nephrotoxic)
- Monitor for signs of infection
- CBC for myelosuppression
Monitoring labs
- Trough levels — narrow therapeutic range
- Trough levels — narrow therapeutic range
- CBC — neutropenia/anemia
Adverse effects
- ★Gingival hyperplasia + hirsutism
- HTN
- ★New-onset diabetes + neurotoxic tremor
- Alopecia
- Diarrhea, GI upset
- Myelosuppression
Black box & toxicity
- ↑ infection & malignancy risk (black box)
- ↑ infection & malignancy risk (black box)
- ↑ infection & malignancy risk (black box)
- ★Teratogen — pregnancy loss/malformation
Contraindications & interactions
- Avoid grapefruit (↑ levels)
- Avoid grapefruit (↑ levels)
- Pregnancy — strict contraception required
Patient teaching
- No live vaccines
- No live vaccines
- No live vaccines
Class & mechanism
Cyclosporine
- Binds cyclophilin → ↓ calcineurin → ↓ IL-2
Tacrolimus
- Binds FKBP → ↓ calcineurin (more potent)
Indications
Cyclosporine
- Transplant rejection prophylaxis
Tacrolimus
- Transplant rejection prophylaxis
Route & administration
Cyclosporine
- PO/IV; avoid grapefruit (CYP3A4)
Tacrolimus
- PO/IV; avoid grapefruit (CYP3A4)
Key assessment
Cyclosporine
- Monitor for signs of infection
- Renal function (nephrotoxic)
Tacrolimus
- Monitor for signs of infection
- Renal function (nephrotoxic)
Monitoring labs
Cyclosporine
- Trough levels — narrow therapeutic range
Tacrolimus
- Trough levels — narrow therapeutic range
Adverse effects
Cyclosporine
- ★Gingival hyperplasia + hirsutism
- HTN
Tacrolimus
- ★New-onset diabetes + neurotoxic tremor
- Alopecia
Black box & toxicity
Cyclosporine
- ↑ infection & malignancy risk (black box)
Tacrolimus
- ↑ infection & malignancy risk (black box)
Contraindications & interactions
Cyclosporine
- Avoid grapefruit (↑ levels)
Tacrolimus
- Avoid grapefruit (↑ levels)
Patient teaching
Cyclosporine
- No live vaccines
Tacrolimus
- No live vaccines
★ marks the fact that sets a column apart.
Clinical Pearl
Cyclosporine grows gums and hair; tacrolimus grows glucose; mycophenolate drops your marrow and your GI.
⚡ Speed Sort This Table
Swipe to sort 52 clinical items into the right bucket