From the Guidelines
There is no specific app recommended for dosing ciclosporin in overweight patients, but using ideal body weight or adjusted body weight rather than total body weight is often recommended for initial dosing calculations, as suggested by the joint american academy of dermatology-national psoriasis foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies 1. When calculating the dose, it's essential to consider the patient's weight, as weight loss may result in improvement in cyclosporine response in obese patients whose body mass index is $30 kg/m2 but <45 kg/m2, as stated in the guidelines 1. Some key points to consider when dosing ciclosporin in overweight patients include:
- The recommended dosage is 2.5-5.0 mg/kg/d in 2 divided doses per day, with dose adjustments downward (by 0.25-1.0 mg/kg) when clearance of psoriasis is achieved or when hypertension or decreased renal function are observed 1
- Dosage adjustments should be based on measured blood levels, clinical response, and side effects rather than relying solely on weight-based calculations
- Therapeutic drug monitoring is essential, with target trough levels typically between 100-400 ng/mL depending on the indication
- Clinicians should be aware of the potential toxicity of ciclosporin, including renal impairment, hypertension, malignancies, and increased risk of infections, as outlined in the guidelines 1. It's crucial to prioritize the patient's safety and adjust the dose accordingly to minimize the risk of adverse effects while maintaining therapeutic efficacy.
From the Research
Dosing Ciclosporin in Overweight Patients
- There is no direct evidence of an app to dose ciclosporin in overweight patients in the provided studies 2, 3, 4, 5, 6.
- However, the study by 6 provides guidelines for the use of ciclosporin in psoriasis clinical practice, including the recommended dose range of 2.5-5.0 mg kg(-1) day(-1).
- The study by 2 mentions that drug absorption varies greatly, necessitating monitoring of drug level and individualization of therapy.
- The study by 4 discusses the importance of renal functional reserve in organ-transplant patients, which may be relevant when considering dosing in overweight patients.
Considerations for Dosing Ciclosporin
- The studies suggest that ciclosporin dosing should be individualized and tailored to the needs of each patient 2, 6.
- Monitoring of renal function and blood pressure is crucial when using ciclosporin 6.
- The use of ciclosporin in combination with other immunosuppressants, such as sirolimus, may also be considered 5.