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.
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Comparison
- Binds cyclophilin then ↓ calcineurin then ↓ IL-2
- Binds FKBP then ↓ calcineurin (more potent)
- ↓ Purine synthesis then ↓ lymphocyte proliferation
- Transplant rejection prophylaxis
- Transplant rejection prophylaxis
- Transplant rejection prophylaxis
- PO/IV
- avoid grapefruit (CYP3A4)
- PO/IV
- avoid grapefruit (CYP3A4)
- PO/IV
- give on empty stomach
- Monitor for signs of infection
- Renal function (nephrotoxic)
- Monitor for signs of infection
- Renal function (nephrotoxic)
- Monitor for signs of infection
- CBC for myelosuppression
- Trough levels — narrow therapeutic range
- Trough levels — narrow therapeutic range
- CBC — neutropenia/anemia
- ★Gingival hyperplasia + hirsutism
- HTN
- ★New-onset diabetes + neurotoxic tremor
- Alopecia
- Diarrhea, GI upset
- Myelosuppression
- ↑ infection & malignancy risk (black box)
- ↑ infection & malignancy risk (black box)
- ↑ infection & malignancy risk (black box)
- ★Teratogen — pregnancy loss/malformation
- Avoid grapefruit (↑ levels)
- Avoid grapefruit (↑ levels)
- Pregnancy — strict contraception required
- No live vaccines
- No live vaccines
- No live vaccines
Cyclosporine
- Binds cyclophilin then ↓ calcineurin then ↓ IL-2
Tacrolimus
- Binds FKBP then ↓ calcineurin (more potent)
Cyclosporine
- Transplant rejection prophylaxis
Tacrolimus
- Transplant rejection prophylaxis
Cyclosporine
- PO/IV
- avoid grapefruit (CYP3A4)
Tacrolimus
- PO/IV
- avoid grapefruit (CYP3A4)
Cyclosporine
- Monitor for signs of infection
- Renal function (nephrotoxic)
Tacrolimus
- Monitor for signs of infection
- Renal function (nephrotoxic)
Cyclosporine
- Trough levels — narrow therapeutic range
Tacrolimus
- Trough levels — narrow therapeutic range
Cyclosporine
- ★Gingival hyperplasia + hirsutism
- HTN
Tacrolimus
- ★New-onset diabetes + neurotoxic tremor
- Alopecia
Cyclosporine
- ↑ infection & malignancy risk (black box)
Tacrolimus
- ↑ infection & malignancy risk (black box)
Cyclosporine
- Avoid grapefruit (↑ levels)
Tacrolimus
- Avoid grapefruit (↑ levels)
Cyclosporine
- No live vaccines
Tacrolimus
- No live vaccines
★ marks the fact that sets a column apart.
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Cyclosporine grows gums and hair; tacrolimus grows glucose; mycophenolate drops your marrow and your GI.
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