McKenna's Pharmacology for Nursing, 2e

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P A R T 3  Drugs acting on the immune system

TABLE 17.2

DRUGS IN FOCUS Antianginal agents

Drug name

Dosage/route

Usual indications

T- and B-cell suppressors abatacept (Orencia)

<60 kg: 500 mg IV repeated at 2 and 4 weeks, then every 4 weeks 60–100 kg: 750 mg IV, repeated at 2 and 4 weeks, then every 4 weeks >100 kg: 1 g IV, repeated at 2 and 4 weeks, then every 4 weeks Adult: 3–5 mg/kg day PO for prevention of rejection; maintenance: 1–3 mg/kg per day PO Rheumatoid arthritis: 1–2.5 mg/kg per day PO; reduce dose with renal impairment Paediatric: 3–5 mg/kg per day IV or PO to prevent rejection; maintenance: 1–3 mg/kg per day PO 15 mg/kg PO as a single oral dose 4–12 hours before transplantation, then 5–10 mg/kg per day PO Paediatric: larger doses may be needed to achieve therapeutic levels 9–15 mg/kg PO as a single oral dose 4–12 hours before transplantation, then 5–10 mg/kg per day PO—titrate down Rheumatoid arthritis: 2.5 mg/kg per day PO in two divided doses Psoriasis: 2.5 mg/kg PO b.d.

Reduction of the signs and symptoms and slowing structural damage in adults with rheumatoid arthritis who have inadequate response to other drugs

azathioprine (Imuran)

Prevention of rejection in renal homotransplants; treatment of rheumatoid arthritis

Suppression of rejection in a variety of transplant situations

cyclosporin (Sandimmun)

(Neoral)

Treatment of rheumatoid arthritis, psoriasis

glatiramer acetate (Copaxone)

20 mg/d SC

Reduction of the number of relapses in multiple sclerosis in adults Prevention of rejection after renal, hepatic, or heart transplantation in adults; not for use in pregnancy

mycophenolate (CellCept)

1–1.5 g PO b.d.; may be started IV during transplantation, with switch to oral route as soon as possible

pimecrolimus (Elidel) sirolimus (Rapamune)

Applied to effected site b.d.

Treatment of atopic dermatitis Prevention of rejection after renal transplantation

6 mg PO as soon after transplant as possible; then 2 mg/day PO Children <13 years: 3 mg/m 2 PO loading dose, then 1 mg/m 2 per day PO

Interleukin-receptor antagonist anakinra (Kineret)

100 mg/day SC

Prevention of rejection after renal or liver transplantation; reduction of the signs and symptoms and slowing structural damage in adults with rheumatoid arthritis who have inadequate response to other drugs Reduction of signs and symptoms and inhibition of structural damage in adults who have moderate to severe rheumatoid arthritis and who have not responded to other drugs Prevention of renal transplant rejection Reduction of the signs and symptoms of Crohn’s disease in adults with moderate to severe disease not controlled by standard therapy

Monoclonal antibodies adalimumab (Humira)

40 mg SC every other week; if also taking methotrexate, may require 40 mg SC once a week

20 mg IV twice—first dose within 24 hours of transplantation, then at 4 days 400 mg subcutaneously, repeated at weeks 2 and 4, then every 4 weeks

basiliximab (Simulect)

certolizumab pegol (Cimzia)