[Examination of administrative dosage of cyclosporine during anti-tuberculosis chemotherapy including rifampicin].
OBJECTIVE
In the treatment of tuberculosis with rifampicin in patients treated with prednisolone and cyclosporine, we have to increase the dosage of these drugs. Although prednisolone dosage is recommended to be doubled, there is no established consensus about cyclosporine dosage. Our aim is to review the current situation at our institution regarding the dosage of cyclosporine administered to tuberculous patients after the addition of rifampicin to the treatment regimen.


RESULTS
We reviewed patients' clinical status and how dosages of cyclosporine were altered during a course of tuberculosis treatment including rifampicin in 4 patients (2 interstitial pneumonitis, 2 collagen vascular disease) who were being treated with cyclosporine between 2001 and 2003. Prednisolone had been also administrated in all patients and the dosage was doubled from the beginning of the treatment. The appropriate dosage of cyclosporine was found to be 2.5-3.5 (average 3) times that of initial dosage, and it required 5-12 weeks (average 8.3) measurements of trough levels and 6-27 (average 12) weeks until appropriate trough levels were obtained.


CONCLUSIONS
The appropriate dosage of cyclosporine was found to be approximately 3 times that of the initial dosage in all patients, but it required a long-term and frequent measurements of trough levels before reaching this goal. It seems that trebling the dosage of cyclosporine from the start of anti-tuberculosis chemotherapy will be an efficient way to achieve good clinical outcome.
Matsui
Yoshinori
Y
Department of Pulmonary Medicine, National Hospital Organization Tokyo National Hospital, 3-1-1, Takeoka, Kiyose-shi, Tokyo 204-8585, Japan. yoshi-matsui@nifty.com
Akagawa
Shinobu
S
Kawashima
Masahiro
M
Suzuki
Junko
J
Masuda
Kimihiko
K
Tamura
Atsuhisa
A
Nagai
Hideaki
H
Nagayama
Naohiro
N
Kawabe
Yoshiko
Y
Machida
Kazuko
K
Kurashima
Atsuyuki
A
Yotsumoto
Hideki
H
D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016572:Cyclosporine / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
D000995:Antitubercular Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D012293:Rifampin