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2.1
Cyclosporine Toxicity

Presentation

In EA cells, swollen mitochondria and large cytoplasmic vacuoles surrounded by a thin membrane containing ribosomes were present at the periphery of the cell. [ncbi.nlm.nih.gov]

In a group of 185 children treated with cyclosporine after bone marrow transplantation, 15 (8%) presented with acute seizures that were generalized in 7 and focal in 7 and had absence status in 1. [moh-it.pure.elsevier.com]

She presented to us on the 3 rd day of rash with 50% body area involvement and mucosal inflammation. She was started on syrup cyclosporine 45 mg/day in divided doses for 7 days. [ijdd.in]

Entire Body System

  • Fatigue

    […] to 10%): Pneumonia, bronchitis, coughing, dyspnea, pharyngitis, rhinitis, sinusitis, upper respiratory tract infection Rare (0.01% to 0.1%): Respiratory distress syndrome Frequency not reported : Bronchospasm [ Ref ] Other Very common (10% or more): Fatigue [drugs.com]

    Cyclosporine toxicity, consisting of fatigue, headache, and GI distress, has been reported by a patient receiving cyclosporine and saquinavir. [pdr.net]

    These side effects may include a slow heart rate, fatigue, muscle weakness, and nausea. [healthline.com]

Gastrointestinal

  • Nausea

    IMDH inhibitors ( Azathioprine /Mercaptopurine) Pancytopenia ( leukopenia, macrocytic anemia, thrombocytopenia ) Infection (e.g., pancreatitis ) Hepatotoxicity Malignancies: e.g., cervical cancer, lymphoma, squamous cell carcinoma, melanoma (rare) Nausea [amboss.com]

    Shaking, headache, dizziness, unusual growth of body hair, nausea / vomiting, diarrhea, stomach upset, or flushing may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly. [webmd.com]

    In cases where cyclosporine toxicity occurs from oral consumption, it's common for a patient to experience a sense of nausea which usually leads to vomiting. [wisegeek.net]

    This condition is marked by: Nausea and vomiting Tremors Jaundice Bleeding Swelling Decreased cyclosporine levels may indicate that more cyclosporine is necessary, in order to achieve a therapeutic dose The laboratory test results are NOT to be interpreted [dovemed.com]

    […] stools cloudy urine cough dark urine decrease in urine output or decrease in urine-concentrating ability decreased appetite dizziness drowsiness fever headache headache, severe and throbbing itching loss of appetite muscle spasms (tetany) or twitching nausea [drugs.com]

Neurologic

  • Headache

    Headaches are another pervasive symptom that is particularly common after an organ transplant has taken place. Once cyclosporine has been put into the bloodstream, it often leads to severe headaches and migraine-like feelings. [wisegeek.net]

    Call your doctor right away or go to the Emergency Department if your see any of these side effects: Fever, chills Cough or sore throat Blood in urine, difficulty urinating, or pain with urination Severe headache Seizures Confusion Shortness of breath [nephcure.org]

    […] blood pressure, which provoke vascular leakage into brain Damage greatest in distribution of posterior cerebral artery Acute or subacute onset of visual impairment Unilateral or bilateral homonymous hemianopia Normal eye examination Confusional state Headache [kellogg.umich.edu]

    headache, severe and throbbing itching loss of appetite muscle spasms (tetany) or twitching nausea and vomiting nervousness painful or difficult urination pounding in the ears shakiness in the legs, arms, hands, or feet shortness of breath skin rash [drugs.com]

    Shaking, headache, dizziness, unusual growth of body hair, nausea / vomiting, diarrhea, stomach upset, or flushing may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly. [webmd.com]

Treatment

Treatment for a cyclosporine overdose may include pumping the stomach, administering activated charcoal, or providing supportive care to treat any symptoms that occur as a result of the overdose. [psoriasis.emedtv.com]

Cytochrome P4503A (CYP3A) activity was reduced in all subjects by a mean level of 26% following clarithromycin treatment. This would result in a significant reduction in cyclosporine clearance in patients receiving clarithromycin. [ncbi.nlm.nih.gov]

By shortening the recovery time, cyclosporine also reduces the cost of the treatment. As indicated in our case report, initiation of cyclosporine therapy is not a contraindication for the treatment of SJS/TEN in HIV-infected patients. [ijdd.in]

[…] mg/dl during, and to 72/22, 1.9/1.7, and 0.6/0.5 mg/dl after cessation of EES treatment. [journals.lww.com]

Prognosis

Special attention has, therefore, been given to topics such as acute liver damage, particu larly within the transplanted liver, to chronic active hepatitis and its spontaneous prognosis, to isolated hepatocytes and their effect on functional support of [books.google.de]

[…] and reversible Thrombotic microangiopathy Resembles hemolytic uremic syndrome Occurs days to weeks after transplantation Glomeruli and vessels show thrombotic microangiopathy with platelet and fibrin thrombi and minimal inflammatory infiltrate Poor prognosis [pathologyoutlines.com]

Younger patients had better prognosis as seen from other studies. [9], [10], [11] The majority of our patients were between 18 and 30 years. [ijdvl.com]

Clinical findings and prognosis factors in 87 patients. Arch Dermatol. 1987; 123 (9):1160–1165. [ PubMed ] [ Google Scholar ] 21. Gueudry J, Roujeau JC, Binaghi M, Soubrane G, Muraine M. [ncbi.nlm.nih.gov]

TEN presents with widespread denudation or peeling of skin, and the prognosis depends on the extent of involvement and the systemic complications, if any, arising from extensive skin loss. [ijdd.in]

Etiology

Two patients did not receive corticosteroids as one had sepsis and in the other the etiology was of viral origin, the patient had chicken pox. [ijdvl.com]

Incidence and drug etiology in France, 1981-1985. Arch Dermatol. 1990; 126 (1):37–42. [ PubMed ] [ Google Scholar ] 5. Rosen AC, Balagula Y, Raisch DW, Garg V, Nardone B, Larsen N, et al. Life-threatening dermatologic adverse events in oncology. [ncbi.nlm.nih.gov]

Epidemiology

Página 259 - Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. [books.google.es]

Epidemiology of erythema exsudativum multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis in Germany (1990-1992): structure and results of a population-based registry. [ncbi.nlm.nih.gov]

Pathophysiology

Clinical and pathophysiologic aspects. Pt 1 J Am Acad Dermatol. 1991; 25 (5):778–786. [ PubMed ] [ Google Scholar ] 38. Viard I, Wehrli P, Bullani R, Schneider P, Holler N, Salomon D, et al. [ncbi.nlm.nih.gov]

Prevention

When this happens, it's important for the patient to be hospitalized to prevent him from falling into a coma. [wisegeek.net]

Cyclosporine ( Gengraf ®, Neoral ®, Sandimmune ® ) is a medication prescribed to prevent organ transplant rejection. It is also used for certain cases of psoriasis and rheumatoid arthritis. [psoriasis.emedtv.com]

Thus, by preventing its production, cyclosporine suppresses the immune system The immune system is responsible for defending the body against foreign invaders. [dovemed.com]

Calcineurin inhibitors, cyclosporine among them, do prevent allograft rejection, but their long term toxicity participates to chronic allograft dysfunction and allograft losses. [theses.fr]

Seite 56 - Zatz R, Dunn BR, Meyer TW, Anderson S, Rennke HG, Brenner BM: Prevention of diabetic glomerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 77: 1925-30, 1986 234. ‎ [books.google.de]

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