Ciclosporin
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Ciclosporin Hypertension in an elderly patient: case report A 75-year-old woman, who had end-stage renal disease and required dialysis, developed hypertension during treatment with ciclosporin for aplastic anaemia. The woman, who had a history of controlled hypertension and anuria, started receiving oral ciclosporin 75mg twice daily (late morning and evening on dialysis days); her concomitant medication included nifedipine, clonidine, metoprolol, atorvastatin, sevelamer, aspirin and vitamins. Erythropoietin therapy was successful over the following few weeks, but severe hypertension with a BP of up to 210/80mm Hg developed [time to reaction onset not clearly stated]. More aggressive ultrafiltration to reduce the woman’s dry weight resulted in severe muscle cramping without reducing her BP. She had a plasma renin activity of < 0.2 ng/mL/h and an aldosterone level of 6.1 ng/dL. Her BP did not react to a clonidine dosage increase and the initiation of lisinopril; after a few weeks, both drugs were stopped. She then discontinued ciclosporin of her own accord and her BP decreased significantly. Due to recurring anaemia, ciclosporin was restarted at a dosage of 25 mg/day. The woman’s systolic BP increased to > 150mm Hg and anaemia did not improve. On a nondialysis day, noninvasive thoracic competence revealed a mildly elevated systemic vascular resistance (SVR) of 1375 dyne sec cm-5. Ciclosporin was increased to 75mg once daily and then further to 100 mg/day. Anaemia became responsive again, but her BP increased to 200/80mm Hg; her SVR was 1874 dyne sec cm-5. Her nifedipine dosage was increased and her BP and SVR normalised. Her inter- and intradialytic BP subsequently remained normal. Author comment: "We suggest that, at least in some patients, [ciclosporin] induces hypertension via increased SVR, likely due to arteriolar vasoconstriction, independent of its sodium retaining effects." Wahba IM, et al. Increased vascular resistance and not salt retention characterizes cyclosporine A-induced hypertension: report in an anuric patient. American Journal 801091072 of Transplantation 7: 2042-2046, No. 8, Aug 2007 - USA
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Reactions 28 Jul 2007 No. 1162
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