Immunosuppressant drugs are used to treat a wide range of health issues, including ulcerative colitis, Crohn’s disease, rheumatoid arthritis, and organ transplants.

Immunosuppressants come in the category of medications that are capable of inhibiting the immune system. Theses medicines are primarily used to lower the body’s ability to reject a transplanted organ (heart, liver, or kidney) and for the treatment of autoimmune diseases, such as psoriasis, Crohn’s disease, sclerederma, and rheumatoid arthritis.

Importance of Immunosuppressants

Immunosuppressant drugs are a fact of life for patients following a liver or kidney transplant. They reduce the strength of the patient’s immune system, but they do not completely remove the immune system. After their transplant, patients are prescribed many medications in high dosages. Different combinations of drugs and small dosages are administered to make a balance between providing enough immunosuppression to keep the problem of rejection away as well as to minimize adverse effects. Your physician may change your dosages over in time, but all patients generally requires a regular medication regimen.

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Immunosuppressive drug therapy

During Immunosuppression, the activation and efficacy of the immune system get reduced. Some immunosuppressants have a diffuse effect on the immune system while others have specific targets. Immunosuppressant drugs are vital for successful organ transplantation and the treatment of autoimmune diseases. They are capable of suppressing rejection and dampen the autoimmune process. However, anti-rejection medicines may also lead to unwanted results of immunodeficiency such as non-immune toxicity, infection, or malignancy. Drugs like thiopurines and glucocorticosteroids are still widely used, but new potent drugs become a keystone of many treatments. The treatment should always be initiated by an expert. Also, careful monitoring of blood counts should be done in patients receiving anti-rejection medicines, and the dosages must be adjusted to prevent bone marrow toxicity.

Immunosuppressive medicines can be grouped as alkylating agents, T-cell inhibitors, and antimetabolites. The group of T-cell inhibitors includes tacrolimus and cyclosporine. The metabolite category includes methotrexate, azathioprine, and mycophenolate mofetil. Because of the fact that immunosuppressant regimen for initial treatment of ocular inflammation include high-dose oral corticosteroid as well.

Ciclosporin- It is a potent immunosuppressant drug, which is used to prevent graft rejection and to prevent graft versus host disease. By kidney function and plasma cyclosporin concentrations, the dosage schedule is adjusted.  It is useful in treating active rheumatoid arthritis that is poorly responsive to methotrexate and in treating plaque psoriasis in adults.

Cyclosporine has been shown to affect preferentially immunocompetent T lymphocytes that are present in G0 and G1 phase of the cell cycle and blocks replication as well as their ability to produce interleukin-2 (lymphokines).

Nephrotoxicity is the most troublesome adverse effect of cyclosporine. Almost, all patients develop some evidence of nephrotoxicity at the dose of 10 mg/kg daily. The probability of this adverse effect appears to be reduced if patients were given 2 to 5 mg per kg daily. The other commonly experience side effect is hypertension. Some rarely experienced adverse reactions include tremor, hypomagnesemia, hepatotoxicity, hirsutism, myalgias, paresthesias, gingival, and hyperplasia. The blood pressure and serum concentrations should be checked on a regular basis.

Azathioprine- Another important medicine to suppress immune system is Azathioprine. This immunosuppressant therapy is common in transplant recipients, especially in combination with other-other drugs such as cyclosporine and prednisone. It is effective when corticosteroid monotherapy is failed or other situation when a dose reduction of currently administered corticosteroid is required. It has been approved by the food and drug administration for the treatment of rheumatoid arthritis. Azathioprine has also been studied in patients with inflammatory eye disease. It effectively treats chronic uveitis, usually along with corticosteroids. The drug is successful in decreasing the rate of development of eye diseases in those without the involvement and decreasing the occurrence of second eye disorder in those with unilateral disease.

It is a purine nucleoside analog, which interferes with guanine and adenine ribonucleotides by suppressing iconic acid synthesis, which in turn disrupts RNA transcription and DNA replication. It decreases the number of T and B lymphocytes and reduces, IgM production, interleukin-2 synthesis, and mixed lymphocyte reactivity.

The medicine should be taken orally at a dose of 1 to 3 per kg daily. 2 mg per kg daily has been shown to most effective dose. The dose should be decreased when used in combination with allopurinol. One of the most commonly occurs side effects of Azathioprine is reversible bone marrow suppression. An increased risk of non-Hodgkin lymphoma has been reported in patients with kidney transplant.

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Methotrexate- This type of immunosuppressant is used to treat a variety of malignancies. It plays a  vital role as a combination therapy for the treatment of breast cancer. The drug is myelotoxic in nature and may also cause mucositis. It is effective in the management of several systematic inflammatoury diseases including systematic lupus erythematosus, juvenile rheumatoid arthritis, rheumatoid arthritis, and psoriatic arthritis.

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