Clinical evidence,mechanism, importance and management
When muromonab-CD3 5mg daily for 10 days was given to 10 kidney transplant patients to treat acute rejection, their mean trough ciclosporin levels on day 8 were higher than before muromonab-CD3 was started, despite a 50 % reduction in ciclosporin dosage. When muromonabCD3 was withdrawn, ciclosporin dosage needed to be increased again (See reference number 1). The reasons are not understood. It is clearly necessary to titrate dosage of ciclosporin downwards if muromonab-CD3 is given to prevent an excessive rise in ciclosporin levels with attendant risks of renal toxicity.
1. Vrahnos D,Sanchez J, Vasquez EM, Pollak R, Maddux MS. Cyclosporine levels during OKT3treatment of acute renal allograft rejection. Pharmacotherapy (1991) 11, 278.