Prophylaxis of acute transplant rejection in patients receiving allogeneic renal, cardiac or hepatic transplants in combination w/ ciclosporine & corticosteroids. Refractory acute transplant rejection in patients receiving allogeneic renal. Induction & maintenance therapy in patients w/ class III-IV lupus nephritis.
Renal transplant Adult 1 g bid initiated w/in 72 hr following transplantation. Childn & adolescent 2-18 yr 600 mg/m2 bid. Max: 2 g daily. BSA 1.25-1.5 m2 750 mg bid (1.5 g daily dose), >1.5 m2 1 g bid (2 g daily dose). Elderly ≥65 yr 1 g bid. Cardiac transplant Adult 1.5 g bid (3 g daily dose). Elderly ≥65 yr 1.5 g bid. Hepatic transplant Adult1.5 g bid (3 g daily dose). Elderly ≥65 yr 1.5 g bid. Lupus nephritis Induction therapy: 750 mg to 1.5 g bid (up to 3 g daily dose). Maintenance therapy: 500 mg to 1 g bid (2 g daily dose).
Increased risk of developing lymphomas & other malignancies, risk for opportunistic infections (bacterial, fungal, viral & protozoal), fatal infections & sepsis. Limit exposure to sun or UV light. Monitor patients for neutropenia & ensure to have CBC wkly during the 1st mth, twice mthly for 2nd & 3rd mth of treatment, then mthly through the 1st yr. Pure red cell aplasia (PRCA). Avoid use of live attenuated vaccines & w/ rare hereditary deficiency of hypoxanthine-guanine phosphoribosyl-transferase (HGPRT) eg, Lesch-Nyhan & Kelley-Seegmiller syndrome. Patients w/ active serious digestive system disease. Pregnancy.
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