From the Guidelines
The recommended dose of cyclosporin for adult patients is 3 to 6 mg/kg per day with a maximum of 200 mg. This dosage range is based on the most recent guidelines from the American Society of Hematology 2019 guidelines for immune thrombocytopenia 1. The dose varies and is adjusted with monitoring of trough drug levels.
Key considerations for dosing include:
- Starting dose: 3 to 6 mg/kg per day
- Maximum dose: 200 mg per day for adults
- Adjustment of dose based on trough drug levels
- Monitoring for adverse effects such as gingival hyperplasia, hypertension, nephrotoxicity, and nausea
It's also important to note that the British Association of Dermatologists guidelines for the safe and effective prescribing of oral ciclosporin in dermatology 2018 recommend a dosage range of 2.5–5 mg kg-1 per day 1. However, the most recent and highest quality study prioritizes the dosage range of 3 to 6 mg/kg per day with a maximum of 200 mg 1.
Regular monitoring of blood pressure, kidney function, and drug levels is essential as cyclosporine has a narrow therapeutic window and significant toxicity potential. Dose adjustments may be needed for patients with liver dysfunction or those taking medications that interact with cyclosporine's metabolism through the CYP3A4 pathway.
From the Research
Recommended Dose of Cyclosporin for Adult Patients
The recommended dose of cyclosporin for adult patients varies depending on the clinical status of the patient and the specific indication for use.
- The initial dose should be the lowest effective one and not exceed 5 mg/kg/day in non-life-threatening conditions 2.
- Intravenous cyclosporine doses range from 2-9 mg/kg/d and oral doses range from 10-50 mg/kg/d; the dosage should be individualized based on the clinical status of the patient as well as blood concentrations of the drug 3.
- Dosages of less than 5 mg/kg/day, however, rarely cause renal side effects 4.
Factors Affecting Cyclosporin Dose
Several factors can affect the dose of cyclosporin required, including:
- Patient's disease state
- Type of organ transplant
- Age of the patient
- Therapy with other drugs that interact with cyclosporin 5
- Gastrointestinal dysfunction
- External bile drainage
- Liver disease
- Food 5
Monitoring of Cyclosporin Blood Concentrations
Monitoring of cyclosporin blood concentrations is necessary to ensure that the patient is receiving an effective dose while minimizing the risk of toxicity.