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Kt
Member
Username: Kt

Post Number: 20
Registered: 02-2010
Posted on Wednesday, May 22, 2013 - 01:31 am:   Edit Post Delete Post Print Post

Hi,
I read on another thread that prograf is a better anti rejection drug than cyclosporin. Was just wondering why this is? Does anyone have any links to articles on this topic?

The reason I ask is, I am 6 months double lung transplant and my docs started me on prograf (tacrolimus) but I couldn't tolerate it very well. I had severe nausea and was vomiting almost daily for 4 months. Finally, they changed me to cyclosporin and the vomiting disapeared. My appetite finally increased and I started feeling so much better. The only side effect I've noticed is excess hair growth especially on my face. Not good when your a girl lol! But concerns me that I might be on a drug that is not as good...

Thanks for your info!
Cystic Fibrosis
Aussie
Jay Lackritz
Forum Leader
Username: Jay_ny

Post Number: 532
Registered: 01-2007


Posted on Wednesday, May 22, 2013 - 02:20 am:   Edit Post Delete Post Print Post

Most of the studies I've read state that there is much improved graft rejection with the newer immunosuppressive. All the studies I have read were done on kidney patients.
Of course, if you tolerate one better than the other, the decision is easy.

Here's part of an interesting article from 2003.

Tacrolimus, previously known as FK506, has replaced cyclosporine for chronic immunosuppression after transplantation at many institutions. Although not structurally related to cyclosporine, tacrolimus has a similar mechanism of action and efficacy. While the adverse effect profiles of the two drugs are also comparable, tacrolimus is better tolerated by some patients, particularly children and adolescents. In addition, tacrolimus use has been associated with fewer episodes of late graft rejection and a reduced need for concomitant steroids. This issue of Pediatric Pharmacotherapy will review the use of tacrolimus in pediatric patients after solid organ transplantation.

Tacrolimus is a macrolide immunosuppressant produced by Streptomyces tsukubaensis. Although the exact mechanism by which tacrolimus produces immunosuppression remains unknown, it appears to act through inhibition of T-lymphocyte activation. Tacrolimus binds to an intracellular protein, FKBP-12, and forms a complex with calcium, calmodulin, and calcineurin. The resulting complex inhibits the phosphatase activity of calcineurin, which prevents the dephosphorylation and translocation of nuclear factor of activated T-cells (NF-AT). NF-AT is believed to initiate gene transcription for the formation of lymphokines such as interleukin-2 and gamma interferon. The clinical result of inhibition of NF-AT is immunosuppression.

In addition, tacrolimus inhibits cell degranulation and apoptosis, blocks activation of nitric oxide synthetase, and potentiates the cellular effects of steroids. Unlike cyclosporine, tacrolimus does not increase levels of transforming growth factor-beta

Read on. A couple of links to studies can be found below.
http://www.medscape.com/viewarticle/457649

Tacrolimus versus ciclosporin as primary immunosuppression
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1246079/

Long-Term Graft Survival with Neoral and Tacrolimus:
http://jasn.asnjournals.org/content/14/11/2980.full.pdf
Jay Lackritz@Optonline.net
Jay Lackritz.com
Bilateral Lung TX, May 10, 2007, Columbia University Medical Center/NYPH
Google doc
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Russ
Member
Username: Rjwitte

Post Number: 148
Registered: 06-2009


Posted on Wednesday, May 22, 2013 - 01:37 pm:   Edit Post Delete Post Print Post

I'd be a little more circumspect with broad statements. I'm not so sure all doctors really think one is greatly better than the other. Many long-term recipients have been on cyclosporine for 20+ years. Tac seems to have a higher incidence of induced diabetes and perhaps nephrotoxicity, cyclosporine can induce higher lipid concentrations and hypertension. As always, your doctors are your best resource.


From the same article quoted above:

While the overall tolerability of tacrolimus and cyclosporine is similar, there are differences which may guide drug selection. In comparison with cyclosporine, the incidence of headache, insomnia, tremor, diarrhea, nephrotoxicity, and hyperglycemia appear to be greater with tacrolimus. Conversely, cyclosporine has been more frequently associated with hirsutism, gingival hyperplasia, constipation, hypertension, and dyslipidemias.[1]
Russ - Heart Txp, 1-1-1999
Univ. of Michigan
Happy2Bhere
Forum Leader
Username: Happy2bhere

Post Number: 4666
Registered: 02-2008
Posted on Friday, May 24, 2013 - 02:21 pm:   Edit Post Delete Post Print Post

" Many long-term recipients have been on cyclosporine for 20+ years."

Yes, I am a 22yr survivor of heart transplant and I continue to take Neoral Cyclosporine, very low daily dose, 50mg per day.
I am 73yrs old and feeling great,
Texas Bob
My Organ Donor Tees

Heart Transplant performed Jan 28th 1991
Bob Heart Transplant Story

Happy2Bhere's Blog

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