• 한국임상약학회지
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• 제7권2호
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• pp.51-63
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• 1997

The effect of cimetidine administration on the pharmacokinetic parameters of cyclosporine were determined in healthy voluteers. This study was performed in 10 volunteers of age ranged 22-48 years and body weight 48-62 kg. This study was performed with cross-over design. Mono cyclosporine and cyclosporine metabolites was extracted from whole blood analysed by fluororescence polarization immune assay (TDX-FLX, Abbott). After coadministration of cimetidine (300 mg) with cyclosporine (300 mg) orally, maximum concentration of mono cyclosporine was significantly increased $1221{\pm}143\;ng/ml\;to\;1562{\pm}184\;ng/ml$ (P<0.05), area under the time curve of cyclosporine (12 hr) also was significantly increased $7478{\pm}829\;ng/ml{\cdot}hr\;to\;9721{\pm}879\;ng/ml{\cdot}hr$ (P<0.05) and absolute baioavailability of cyclosporine was increased $50\pm5.6\%\;to\;57.6\pm6.1\%\;(P<0.05)$ compared to control group. The blood concentrations of cyclopsorine metabolites were significantly decrased (P<0.05) after coadministration of cimetidine. In cimetidine pretreated group, blood mono cyclosporine concentrations were increased significan시y $1220.0\pm203.00\;ng/ml\;to\;1510.0\pm204.00\;ng/ml$ compared with control group (P<0.05). In the mono cyclosporine pharmacokinetic parameter after oral administration absorption rate and maximum concentration were significantly higher in cimetidine coadministered and pretreated group than control group (P<0.05). The ratio of metabolites and mono cyclosporine concentrations was decreased significantly from $70.8\%\;in\;control\;to\;34.8\%$ in coadministration of cimetidine orally. As matter of facts these reults are considered to inhibition of cyclosporine hepatic metabolism and increasing of cyclosporine absorption rate in gastrointestinal tract because of maintaining cyclosporine stability in elevated gastric pH by cimetidine. We considered, it appeares that cimetidine increase bioavailability of cyclosporine by increasing oral absorption and by decreasing hepatic clearance. But the absorption and clearance of cyclosporine was highly variable individually, and therefore we consider that cyclosporine blood level monitoring would be essential in patients with cimetidine co-administration.

• The Korean Journal of Physiology and Pharmacology
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• 제3권6호
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• pp.631-640
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• 1999

The present study investigated the stimulatory effects of iron (or ascorbate) on cyclosporine-induced kidney mitochondrial damage. Damaging effect of $50\;{\mu}M$ cyclosporine plus $20\;{\mu}M\;Fe^{2+}$ on mitochondrial lipids and proteins of rat kidney and hyaluronic acid was greater than the summation of oxidizing action of each compound alone, except sulfhydryl oxidation. Cyclosporine and $100\;{\mu}M$ ascorbate showed an enhanced damaging effect on lipids but not on proteins. The peroxidative action of cyclosporine on lipids was enhanced with increasing concentrations of $Fe^{2+}.$ Ferric ion $(20\;{\mu}M)$ also interacted with cyclosporine to stimulate lipid peroxidation. Damaging action of cyclosporine on mitochondrial lipids was enhanced by ascorbate $(100\;{\mu}M\;and\;1\;mM)$. Iron chelators, DTPA and EDTA, attenuated carbonyl formation induced by cyclosporine plus ascorbate. Cyclosporine $(100\;{\mu}M)$ and $50\;{\mu}M\;Fe^{2+}$ $(or\;100\;{\mu}M\;ascorbate)$ synergistically stimulated degradation of $2-{\alpha}$ deoxyribose. Cyclosporine $(1\;to\;100\;{\mu}M)$ reduced ferric ion in a dose dependent manner, which is much less than ascorbate action. Addition of $Fe^{2+}$ caused a change in absorbance spectrum of cyclosporine in $230{\sim}350$ nm of wavelengths. The results show that cyclosporine plus iron (or ascorbate) exerts an enhanced damaging effect on kidney mitochondria. Iron and ascorbate appear to promote the nephrotoxicity induced by cyclosporine.

• Childhood Kidney Diseases
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• 제2권1호
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• pp.20-25
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• 1998

목적 : Endothelin-1은 cyclosporine A와 관련된 신독성의 발생에 관련될 것으로 생각되고 있다. 이에 저자 등은 cyclosporine A가 혈액 및 요중 endothelin-1치에 미치는 영향을 알아보고자 하였다. 방법 : 1996년 2월부터 1997년 3월까지 스테로이드 의존성 미세변화형 신증으로 진단받고 cyclosporine A를 투여받은 15세 미만의 환아 9례를 대상으로 cyclosporine A 투여 전과 투여 3개월 후의 혈장과 소변에서 endothelin-1치를 측정하였다. 평균 연령은 $8.3{\pm}4.6$세였다. 결과 : (1) 혈중 endothelin-1치는 cyclosporine A 투여 전에 $3.22{\pm}0.39$ pg/mL였고, cyclosporine A 투여 3개월 후에 $3.84{\pm}1.52$ pg/mL로 유의한 차이가 없었다(P=0.64). (2) 요중 endothelin-1치는 cyclosporine A 투여 전에 $21.8{\pm}5.8$ pg/mL였고 cyclosporine A 투여 3개월 후에 $20.3{\pm}3.1$ pg/mL로 유의한 차이가 없었다(P=0.30). 결론 : 혈액 및 요중 endothelin-1치는 비교적 단기간의 cyclosporine A 투여에 의해서는 유의한 변화를 보이지 않았으며, 향후 장기간의 cyclosporine A 투여가 endothelin-1치에 미치는 영향에 대한 연구도 필요할 것으로 생각된다.

• Clinical and Experimental Pediatrics
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• 제51권3호
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• pp.293-298
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• 2008

목 적 : 스테로이드 저항성 신증후군에서 cyclosporine의 반응 효과, 반응 시기, 부작용 및 다른 치료제에 대한 반응을 비교 분석하고자 하였다. 방 법 : 1989년 6월부터 2006년 8월까지 서울아산병원 소아과를 방문한 신증후군 환아 중 초기에 스테로이드 치료에 반응하지 않아 신장 조직 검사 시행 후 cyclosporine을 사용한 22명을 대상으로 cyclosporine의 반응 효과, 반응 시기, 부작용 및 다른 치료제에 대한 반응을 후향적으로 조사하였다. 결 과 : 총 22명중 미세변화형은 12명(54.5%), 국소 분절 사구체 경화증 8명(36.4%), 메산지움 증식 사구체 신염 1명(4.5%), 막성 사구체 신염 1명(4.5%) 이었다. 진단 당시의 평균 연령은 $5.2{\pm}3.3$세이었으며 남녀 비는 1.2:1 이었다. 22명중 15명(68.2%)에서 cyclosporine에 반응하였는데, 이중 미세변화형이었던 환아는 11명(91.7%), 국소 분절 사구체경화증이었던 환아는 3명(37.5%)(미세변화형 vs 국소 분절 사구체경화증, P<0.05), 그리고 막성 사구체 신염 1명이었다. 관해 시기는 cyclosporine 사용 후 $31.5{\pm}15.2$일이었다. Cyclosporine에 반응을 보인 15명 중 4명은 약물 사용 없이 관해 상태이고, 7명은 cyclosporine 사용 중이며, 2명은 cyclosporine 중단 후 스테로이드를 간헐적으로 사용하고 있고, 2명은 cyclosporine과 스테로이드를 함께 투여하고 있다. 이들의 cyclosporine 사용 기간은 각각 $546.5{\pm}346.2$일, $1,392.9{\pm}439.7$일, $439.5{\pm}84.1$일, $433.5{\pm}74.2$일이었다. Cyclosporine 사용 기간 중 혈청 크레아티닌의 변화는 없었으나 신장조직검사를 시행한 8 명중 2 명에서 간질의 섬유화와 세뇨관의 위축이 부분적으로 관찰되었다. 결 론 : 스테로이드 저항성 신증후군에 있어 cyclosporine의 반응은 비교적 좋은 편이고, 특히 미세변화 신증후군에서 그 효과가 높다. 그러나 관해를 유지하기 위해서는 장기간 사용하여야 하는 문제점이 있다.

• Childhood Kidney Diseases
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• 제1권2호
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• pp.179-182
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• 1997

Cyclosporine is an immunosuppressant usually used to prevent renal transplantation rejection. Nephrotoxicity and hypertension are considered as the most frequent side effects of cyclosporine treatment. The neurotoxic effects of cyclosporine such as agitation, anxiety, delirium, depression and psychosis have recently been found. Methylprednisolone may increase as well plasma concentration of cyclosporine, which leads to side effects. Here we report a $Henoch-Sch\"{o}nlein$ nephritis patient treated with cyclosporine and methylprednisolone who has experienced psychosis including visual and auditory hallucination and convulsion.

• 약학회지
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• 제46권4호
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• pp.265-269
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• 2002

The purpose of this study was to report the pharmacokinetic changes of cyclosporine after oral administration of cyclosporine, 10 mg/kg, in rabbits coadministered or pretreated twice per day for 3 days with nimodipine, dose of 5 mg/kg. The area under the plasma concentration-time curve (AUC) of cyclosporine was significantly higher in rabbits pretreated with nimodipine than that in control rabbits (p＜0.01), showing about 149％ increased relative bioavailability. The peak plasma concentration (C$_{max}$), elimination half-life (t$_{1}$2/) and MRT of cyclosporine were increased significantly (p＜0.05) in rabbits pretreated with nimodipine compared with those in control rabbits. This findings could be due to significant reduction of elimination rate constant and total body clearance by pretreated with nimodipine. The effects of nimodipine on the pharmacokinetics of oral cyclosporine were more considerable in rabbits pretreated with nimodipine compared with those in control rabbits. The results suggest that the dosage of cyclosporine should be adjusted when the drug would be coadministered chronically with nimodipine in a clinical situation.n.

• 한국임상약학회지
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• 제10권1호
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• pp.19-24
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• 2000

The effect of cimetidine on the pbarmacokinetic parameters of cyclosporine (intravenous administration) were determined in 6 healthy volunteers (22-48 years old, 48-62 kg) by cross-over design. Cyclosporine and cyclosporine metabolites in whole blood were analysed by fluororescence polarization immunoassay (TDx-FLX). The blood concentrations of cyclosporine After pretreatment with cimetidine (200 mg bid, for 3days) were increased significantly at 8-12 hrs compared to the control (p<0.05). The ratios of blood concentrations of cyclosporine metabolites (M1, M17) to parent drug were decreased significantly at 8-12 hrs (p<0.05). Total body clearance (CL) was also decreased significantly (p<0.05), and area under the curve $(AUC,\%)$ was increased but not significant.

• 한국임상약학회지
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• 제9권1호
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• pp.66-70
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• 1999

The effect of circadian rhythm on cyclosporine pharmacokinetics was studied in rabbits after oral administration of 10 mg/kg dose of cyclosporine at 10:00 a.m. and 10:00 p.m. The blood concentration data were subjected to simultaneous computer nonlinear least squares regression analysis using a 1-compartment pharmacokinetic model. The blood concentrations of cyclosporine at 10:00 a. m. were increased significantly during 2-6 hr compared to those at 10:00 p.m. The area under the blood concentration-time curve (AUC) and peak concentration $(C_{max})$ of cyclosporine at 10:00 a.m. were increased significantly compared to those at 10:00 p.m. The mean total body clearance (CL) of cyclosporine at 10:00 a.m. were decreased significantly compared to those at 10:00 p.m. It is reasonable to consider individual circadian rhythm for effective dosage regimen of cyclosporine in therapeutics.

• 한국임상약학회지
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• 제28권1호
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• pp.24-29
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• 2018

Background: Cyclosporine is an immunosuppressive agent used to treat and prevent graft versus host reaction (GVHR)-a complication associated with stem cell transplantation. This study aimed to develop a population pharmacokinetic model of cyclosporine and investigate factors affecting cyclosporine clearance in pediatric hematopoietic stem cell transplant patients. Methods: A total of 650 cyclosporine concentrations recorded in 65 patients who underwent hematopoietic stem cell transplantation were used. Data including age, sex, weight, height, body surface area (BSA), type of disease, chemotherapy before stem cell transplantation, type of donor, serum creatinine levels, total bilirubin concentration, hematocrit value, and type of concomitant anti-fungal agents and methylprednisolone used were retrospectively collected. Data related to cyclosporine dosage, administration time, and blood concentration were also collected. All data were analyzed using the non-linear mixed effect model; a two-compartment model with first-order elimination was used. Results: The population pharmacokinetic model of cyclosporine using the NONMEM program was as follows: $CL(L/h)=5.9{\times}(BSA/1.2)^{0.9}$, V2 (L) = 54.5, Q (L/h) = 3.5, V3 (L) = 1080.0, $k_a(h^{-1})=0.000377$. BSA was selected as a covariate of cyclosporine clearance, which increased with an increase in BSA. Conclusion: A population pharmacokinetic model for Korean pediatric hematopoietic stem cell transplant patients was developed, and the important factor affecting cyclosporine clearance was found to be BSA. The model might contribute to the development of the most appropriate dosing regimen for cyclosporine. Further studies on population pharmacokinetics should be carried out, prospectively targeting pediatric patients.

• Journal of Periodontal and Implant Science
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• 제24권2호
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• pp.238-254
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• 1994

Cyclosporine A is an immunosuppressant commonly used for patients receiving organ transplants. Gingival overgrowth is an adverse side-effect seen in about 8-26% of patients taking cyclosporine A which have been shown to increase the DNA synthesis of gingival fibroblast at the concentration of $10^{-9}g/ml$ in vitro. Glycyrrhetinic acid is the active pharmacological ingredients of licorice which exerts steroid-like action and anti-viral activity. Oleanolic acid, which were isolated from Glechoma hederacea, has been shown to act as inhibitors of tumor promotion in vivo and to be less cytotoxic retinoic acid. This study has been performed to evaluate the effects of glycyrrhetinic acid and oleanolic acid on cyclosporine A induced cell activity in vitro. Human gingival fibroblasts were isolated from explant cultures of healthy gingiva of orthodontic patients. Gingival fibroblasts were trypsinized and transferred to the walls of microtest plates. Fibroblasts were cultured in growth medium added $10^{-9}g/ml$ cyclosporineA and $50{\mu}l/ml$ lipopolysaccharides. Cells between the 4th and 6th transfer in culture were used for this study. The morphology of gingival fibroblst were examined by inverted microscope. The effects of cyclosporine A on the time course of DNA sythesis by human gingival fibroblasts were assessed by $[^3H]-thymidine$ uptake assays. Cyclosporine A was found to stimulate DNA synthesis of human gingival fibroblast at a concentration of $10^{-9}g/ml$. In the presence of lipopolysaccharide derived from Fusobacterium nucleatum, addition of cyclosporine A results in reversal of inhibition at the concentration which normally inhibits gingival fibroblast proliferation. The cell acitivities in the presence of glycyrrhetinic acid and oleanolic acid were decreased, and increased cell acitivities by cyclosporine A were decreased by glycyrrhetinic acid and oleanolic acid at the concentration of $200{\mu}g/ml$. These results suggested that the increased cell activities by cyclosporine A modulated by glycyrrhetinic acid and oleanolic acid.