and pulmonary transplant immunosuppression is unclear and
requires further study. The side effect profile of corticosteroid
therapy is well documented.
In addition to regular monitoring of drug levels and haemato-
logical (full blood count) and biochemical (renal and hepatic
function, blood glucose) indices, one should be aware of drug
interactions which may reduce or increase the levels or
effectiveness of immunosuppressive agents. For example drugs
which promote hepatic enzyme induction (e.g. anticonvulsants,
antituberculous therapy) will reduce cyclosporin-A levels.
Certain antibiotics (e.g. erythromycin) and calcium channel
blockers (e.g. diltiazem) will increase cyclosporin-A levels.
Similar interactions apply to tacrolimus. Non-steroidal anti-
inflammatory agents can potentiate nephrotoxicity when given
with cyclosporin-A or tacrolimus. The dose of azathioprine has to
be reduced by 70% if patients are also prescribed allopurinol.
FFuurrtthheerr rreeaaddiinngg
Madden B. Late complications following cardiac transplantation. Br Heart J
1994; 7722 : 89–91.
Madden B, Kamalvand K, Chan CM et al. The medical management of
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Madden BP. Immunocompromise and opportunistic infection in organ
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