title: [The cardiologist and immunosuppressive therapy].
abstract: The monitoring of immunosuppressive therapy may involve the cardiologist in various settings. TNF inhibitors are contra-indicated in patients with NYHA III-IV cardiac failure. This contra-indication is not absolute for etanercept. In patients with milder forms of cardiac failure, TNF inhibitors can be prescribed in the absence of alternative therapy. A cardiac follow-up is necessary in this situation. Cyclosporine and tacrolimus are both nephrotoxic and hypertensive drugs. For the treatment of arterial hypertension induced by the immunosuppressive therapy, first-line recommended drugs are calcium-blockers and renin-angiotensin inhibitors. Other antihypertensive classes may also be used in these patients. Calcium-blockers may cause frequent oedema and plasma calcineurin-inhibitor concentration elevations. Moreover, cyclosporine+calcium-blocker association may induce gingival hypertrophy and gynecomastia.
authors.affiliation: Hôpital de la Timone, service de cardiologie, 13385 Marseille, France. pierre.ambrosi@ap-hm.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Ambrosi
authors.forename: Pierre
authors.initials: P
authors.lastname: Lafforgue
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D002309:Cardiology; D006333:Heart Failure / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000188:drug therapy*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects / Q000494:pharmacology*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha