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I've been doing a lot of research on Cyclosporine and dosing. One thing that I thought might benefit the group is that there are a number of articles (including a warning from the drug manufacturer) that "the risk of renal structural changes is greater if the serum creatinine increases more than 30% from the patient's baseline value." I don't think most doctors track a patient's baseline. So, it's up to us to monitor this and evaluate the risks.
My creatinine had increase 78% over my baseline and my GFR had fallen. So, we lowered my dosage to 5 mg/kg/day despite the fact that my trough is below 100 on this dosage. I'm still waiting to see how my kidneys recover.
I also read some articles that mentioned that for people like me with atypical metabolisms, measuring the levels 2 hours after dosage is more accurate for predicting the drug availability than the trough. When I had my level measured 2.5 hours after dosage, it was over 600 despite being on the lower dosage. So, I'm feeling more comfortable with my "low dosage and trough" and will never go on the mega-dosage again!
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55 yo female, dx 9/08, AA/hypo-MDS, subclinical PNH, ATG/CsA 12/08, partial response. small trisomy 6 clone, low-dose cyclosporine dependent
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