Drug Interactions with Commonly used Immunosuppressive Agents

Anesthetic and Perioperative Management of Adult Transplant Recipients in Nontransplant Surgery

“…All immunosuppressive drugs now in use have significant side effects that may have a direct impact on anesthetic and perioperative management (8) ( Table 2). Drugs that may cause renal dysfunction when administered with cyclosporine or tacrolimus are presented in Table 3 (8). Generalized major motor seizures are a serious complication of cyclosporine or tacrolimus therapy.…”

“…Antithymocyte globuline (ATG) also may be responsible for thrombocytopenia. Drugs that may cause marrow toxicity when given to patients receiving azathioprine include allopurinol, angiotensin-converting enzyme inhibitors, sulfasalazine, and 5-amino salicilate acid (8).…”

“…Steroids are used for the prevention of rejection and for the treatment of acute rejection episodes. Despite intense effort to eliminate or replace them, steroids are still a mainstay of the posttransplant immunosuppression protocol, and their long-term use may result in steroid-related side effects (8).…”

“…The presence of an infection should also always be ruled out preoperatively. Infection is a significant cause of morbidity and mortality after transplantation (5,8,31,32,34). Immunosuppressed patients are at risk of infections that may be bacterial, viral, fungal, or protozoan (5,31,32,34).…”

“…The oral dose of prednisone is equal to the IV methylprednisolone dose. Oral and IV doses of azathioprine are approximately equivalent (8,56). Supplemental "stress-coverage" steroids are probably not necessary, except in transplant recipients recently withdrawn from them (39,57,58).…”