Interactions Between Cyclosporin and Lipid-Lowering Drugs

@article{sberg2012InteractionsBC,
  title={Interactions Between Cyclosporin and Lipid-Lowering Drugs},
  author={Anders Nikolai {\AA}sberg},
  journal={Drugs},
  year={2012},
  volume={63},
  pages={367-378}
}
  • A. Åsberg
  • Published 2012
  • Biology, Medicine, Chemistry
  • Drugs
Dyslipidaemia is more frequent in solid organ transplant recipients than in the general population, primarily as a result of immunosuppressive drug treatment. Both cyclosporin and corticosteroids are associated with dyslipidaemic adverse effects. In order to reduce the overall cardiovascular risk in these patients, lipid-lowering drugs have become widely used, especially HMG-CoA reductase inhibitors (statins). Cyclosporin, as well as most statins (lovastatin, simvastatin, atorvastatin and… 
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[Hypolipidemic treatment under special conditions: posttransplant and/or immunosuppressive therapy].
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  • 2005
TLDR
Pravastatin appears to be the safest compound, once it is glucuronized, and when combined with any statin a careful monitoring of cyclosporine levels is recommended, due to a narrow therapeutic window of the immunosuppressive agent.
Treatment of dyslipidemia in kidney transplantation
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Rather than using high-dose statin in difficult patients, an association with ezetimibe is suggested, and new lipid-lowering drugs are emerging but their safety and efficacy in KT patients still need to be assessed.
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Clinicians are encouraged to develop their knowledge of CYP-mediated DDIs so that they can choose safe drug combination regimens, adjust drug dosages appropriately and conduct therapeutic drug monitoring for drugs with narrow therapeutic indices.
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An up-to-date summary of functional polymorphisms of enzymes involved in the metabolism of immunosuppressants with low molecular weight and of the clinical significance of metabolic drug interactions between Immunosuppressive agents and other drugs in therapeutic regimens of transplant recipients is provided.
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An overview of CsA-induced hyperlipidemia is given, with a focus on the data available that might explain the underlying mechanism(s) and the available treatment regimes used to treat hyper Lipidemia induced by immunosuppressant drugs are described.
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The main dose-dependent adverse events of mTOR inhibitors are hyperlipidemia, thrombocytopenia, mucositis, edema, and proteinuria; the use of m TOR inhibitors in renal transplantation may allow to reduce the doses of calcineurin inhibitors.
Statin use and incident cardiovascular events in renal transplant recipients
TLDR
The effect of statins on a compound CV endpoint, comprised of ischaemic CV events and CV mortality in RTR, is elucidated, with subgroup analysis focussing on cyclosporine users.
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