title: [Low cyclosporin levels induced by the brief use of rifampicin; immunosuppression may fail for several weeks].
abstract: Cyclosporin is an immunosuppressive agent with a wide range of therapeutic uses. In transplant patients, it is used for the prevention of rejection and graft-versus-host reactions. The metabolism and bioavailability of cyclosporin can be significantly and persistently influenced through induction of CYP3A4 caused by the concomitant use of rifampicin. However, awareness of the need for the timely and frequent monitoring of cyclosporin levels during and especially after treatment with rifampicin has not fully been addressed. Here, we describe 3 patient cases concerning significant episodes of sub-therapeutic cyclosporin levels after short-term rifampicin therapy. Rifampicin was administered for three to five days and decreased cyclosporin levels were observed ± 7 days after the initiation of rifampicin, and continued during the following weeks even after the cessation of rifampicin therapy. Cyclosporin dosage-adjustments were made based on the cyclosporin blood levels and all 3 patients showed good therapeutic and clinical responses.
authors.affiliation: Amphia Ziekenhuis, Afd. Klinische Farmacie, Breda, the Netherlands. cvalk@fzr.nl
authors.forename: Corinne G H
authors.initials: CG
authors.lastname: Valk-Swinkels
authors.forename: Fazil
authors.initials: F
authors.lastname: Alidjan
authors.forename: Mirjam K
authors.initials: MK
authors.lastname: Rommers
authors.forename: René  C
authors.initials: R
authors.lastname: Bakker
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Swen
authors.forename: Nils E
authors.initials: NE
authors.lastname: van 't Veer
mesh_terms: D001682:Biological Availability; D002675:Child, Preschool; D016572:Cyclosporine / Q000493:pharmacokinetics*; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics*; D007223:Infant; D008297:Male; D008875:Middle Aged; D012293:Rifampin / Q000494:pharmacology*
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D012293:Rifampin