Cyclosporine Toxicity & Fish Oil

Cyclosporine is a difficult drug to manage. Not only is getting a consistent serum concentration difficult, it also can cause some of the very conditions that it is calculated to cure. This paradoxical effect happens with several kidney immunopressants, including tacrolimus. Regular monitoring prevents problems from getting worse.

Cyclosporine Toxicity

More than any other drug, the immunosuppressant cyclosporine helped make kidney transplants widely available. An article in the February 2009 "Clinical Journal of the American Society of Nephrology" explains how the introduction of cyclosporine in the late 1970s revolutionized transplantation medicine. Prior to that time, kidney transplants were a hit and miss affair, dogged by rejection problems.

While other immunosuppressants are available, cyclosporine, also known as CsA, continues to be an important part of post-transplant immunosuppression regimens. One downside to this drug is that it is nephrotoxic, or hazardous to the kidneys. Kidney patients are closely monitored so that they take as high a dose as necessary to prevent rejection, and as low a dose as possible to prevent nephrotoxicity.

Fish Oil

Fish oil contains the omega-3 fatty acids docosahexaenoic acid and eicosapentaenoic acid, better known as DHA and EPA. While scientists continue to evaluate the therapeutic efficacy of fish oil in treating a number of disorders, the FDA approved a particular brand of fish oil for the treatment of high triglyceride levels.

Fish oil first got the attention of the kidney community when Dr. James Donadio published a 1999 paper in the "Journal of the American Society of Nephrology" showing that fish oil slowed the progression of IgA nephropathy, an immunologically mediated kidney disease.

CsA Nephrotoxicity

Although Donadio's results had yet to be consistently replicated, researchers began evaluating the therapeutic efficacy of fish oil for other problems related to kidney disease such as reducing the nephrotoxicity of CsA. Clinical studies in humans have yet to be performed. Studies in rats are not entirely convincing. An article in the 2011 issue of "Renal Failure" suggested that DHA might alleviate CsA nephrotoxicity, as evidenced by the lower levels of protein in rat urine. Other studies, such as the one appearing in the November 2006 "Archives of Medical Research," suggested that the improvement was very modest.

Warning

Patients on CsA need to be evaluated every few weeks to measure the trough level of drug present in their bodies. The trough level is the lowest concentration of drug during a dosing regimen. Doctors also measure urine protein to watch for CsA toxicity, disease recurrence and rejection. Frequent evaluation allows doctors to change immunosuppressant regimens as needed.

Cyclosporine Toxicity & Fish Oil