Cyclosporine and low-dose ketoconazole in renal transplant recipients: a single-center experience.
BACKGROUND
The high cost of cyclosporine A (CsA) is an impediment for low-income patients. Previous studies have used ketoconazole at doses between 200 and 400 mg/day to lower CsA consumption.


METHODS
Ketoconazole and CsA were administered prospectively to renal transplant patients. Patients treated historically with CsA were used as a reference group. At different intervals posttransplant, clinical and laboratory data were recorded.


RESULTS
The reference group (n=14) was treated with CsA from 1992 to 1997 and the CsA plus ketoconazole group (n=17) from 1998 to 2002. Follow-up was 76+/-22 and 29+/-14 months, respectively. CsA doses throughout the study were 4.0+/-1.3 and 1.6+/-0.6 mg/kg/day (a 60% reduction, P =0.00). Trough levels of CsA were 194+/-87 and 193+/-69 ng/mL, respectively. The ketoconazole dose was 54+/-17 mg/day. The monthly cost of CsA was reduced by 60%, including the cost of ketoconazole.


CONCLUSIONS
CsA with ketoconazole resulted in a substantial dose and cost reduction that proved safe and effective.
Carbajal
Hector
H
Escuela de Medicina, Ignacio A. Santos del Instituto Tecnologicóy de Estudios Superiores de Monterrey and the State of Nuevo León Organ and Tissue Transplant Registry, Monterrey, Mexico. hcarba@intercable.net
Soltero
Liliana
L
Rodríguez-Montalvo
Carlos
C
Valdés
Alejandro
A
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007654:Ketoconazole / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged
D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D007654:Ketoconazole