Dirty Facts About Prednisone Uncovered

Prednisone isn’t soluble in water, and so is unable to be given intravenously. It is not like drugs which can be stopped cold turkey or abruptly. It is produced by dehydrogenation of cortisone. It is a type of oral corticosteroids that is used to reduce inflammation. The synthetic hormone prednisone is utilized to take care of several ailments.

Prednisone is among the most frequently prescribed synthetic glucocorticoid drugs. It has been known to cause long-term effects which itas advisable to fully understand to offer you the most informed decision when considering the use of the drug. It is one of the most effective drugs available in the market today. As mentioned above, it is one of the most effective drugs available in the market and used for the treatment of autoimmune disorders. It comes under the category of drugs called corticosteroids. At the same time, it is one of the crucial drugs used in treatment of certain types of cancer like the non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, etc.. Prednisone might also be prescribed to individuals who have to undergo imaging methods, like CT scan, that involve the usage of intravenous dyes.

Prednisone has to be discontinued gradually. It is no exception. It, like all other drugs, has side effects that can affect your pet. You fear taking Prednisone or any other sort of medicine for Psoriasis.

The War Against Prednisone

Discontinuation of prednisone has to be carried out gradually, according to the instructions of your physician. Prednisone withdrawal needs to be gradual in order to help the body to begin producing cortisol needed to carry out its various functions. In any case, consuming alcohol together with prednisone also is dependent on your general well-being and tolerance levels.

A Startling Fact about Prednisone Uncovered

Prolonged use of prednisone can impact the human body’s capacity to make natural corticosteroids, thereby increasing the probability of drug dependence. Long-term use of prednisone may also make dogs susceptible to metabolic adjustments, together with a greater chance of turning diabetic. Therefore, usage of prednisone during early pregnancy ought to be avoided.

Prednisone treatment may not be stopped abruptly. Generally, it begins with a high dose which is gradually reduced over a period of few weeks. In some instances, the side effects of prednisone can end up being life-threatening. Prednisone side effect affects these areas with time or elongated use of the drug. Taking prednisone alongside alcohol can cause severe interactions. Also, prednisone and alcohol reactions can differ in the instance of distinct drugs.

Prednisone Options

Prednisone resembles cortisol. In short, it must not be taken without the prescription of a doctor. The medication Prednisone exists as a sort of glucocorticoid.

When you’re on prednisone, your skin will normally clear up in a few days. Prednisone is one such drug that’s utilized to take care of a plethora of ailments in young children. It is placed under a class of drugs called corticosteroids. It is a very helpful and strong steroid which is used in treating numerous diseases. An individual must remember that while prednisone definitely does give rise to numerous side effects, it’s additionally a life-saving drug.

When you get off prednisone, it’s probable your eczema will rebound, but after you have some superior skin care regimen in place, the transition will not be as difficult. Prednisone is usually utilized as an oral medication. Make certain you take prednisone for the suggested quantity of times and in recommended amounts. In these cases too, resuming prednisone is the perfect solution.

The dosage is dependent upon the weight of the cat. It would depend on the condition that is being treated as well as the dog’s response to the treatment. If it calls for tapering, it is very important to follow the instructions carefully. Be certain that you administer the most suitable dosage, and if you don’t remember to provide your pet a dose of cephalexin, do not double the amount the next moment.

Secrets About Prednisone For Dogs Exposed

It is a drug that is used to treat different ailments in the dogs since it is a highly effective drug but sometimes it can also leave some side effects on the dogs. It is a helpful substance for aiding dogs with a number of different illnesses, however, you should be aware of the possible drug interactions and contraindications of its use. It is a very powerful anti-inflammatory drug. It is a corticosteroid that has to be converted to prednisolone in the liver in order for it to have its effect on the body.

Prednisone is a lot cheaper. It is similar to cortisol. It is one of the most commonly prescribed steroids in both human and veterinary medicine. Unfortunately, Prednisone for dogs comes with a great deal of side effects also.

Be certain that you administer the most suitable dosage, and if you don’t remember to provide your pet a dose of cephalexin, do not double the amount the next moment. Make sure you administer the dosage depending on the recommendations of the veterinarian. The dosage is dependent upon the weight of the dog. It depends on the product used. The dosage will be different depending on the weight of your dog and seriousness of dehydration. Dramamine dosage is extremely determined by your dog’s weight.

The dosage is decided by your vet. Though it depends on the severity of the dog’s condition, doses in the range of are routinely administered. It will vary depending upon the weight of the dog. It must always be given in the amount recommended by the vet. It would depend on the condition that is being treated as well as the dog’s response to the treatment. Prednisone dosage for dogs depends upon the status that’s being treated.

How to Choose Prednisone For Dogs

Some dogs may seem to drool excessively too. They may have multiple allergies. Overweight dogs are more inclined to suffer from arthritis. Because of its sedative effect, the dog may turn into a little lethargic, which isn’t a cause of grave concern. Dogs that are on prednisone might even become prone to skin infections, that are hard to heal. Dogs on prednisone for quite a while, have to be tapered even more gradually.

When a dog is place on Fentanyl, usage of any other pain relieving drug ought to be strictly avoided. Make certain you take your dog for a walk at least for a couple of minutes. Every dog reads the textbook a bit differently! At first, the dog could be extended a bigger dose and then the dose may be reduced as the condition improves. Pregnant dogs aren’t suited to treatment with ciprofloxacin. They are not a candidate for Dramamine, as the medication can affect the fetus negatively.

Not all dogs will have side results and steroids might be the very best treatment option in some specific circumstances. Dogs who aren’t eligible for surgeries are given Fentanyl to lessen pain and boost their lifespan. According to the manufacturers, they should not be fed for at least 1 hour prior to giving Cerenia. Dogs affected by osteoarthritis frequently have pain and stiffness which affects their mobility and general quality of life.

Dogs are equally as fragile as us humans when it has to do with their wellbeing, and for that reason it is perfect to take them for regular checkups and make sure they are healthy and fit. Thus, it’s extremely rare in dogs which were vaccinated. To begin with, your dog will most likely be more lethargic. With the correct medication and wellness management, your dog would have the capacity to lead a pain-free life. If your dog is affected by motion sickness, it is wise to give a small sum of food about two hours before traveling. Following your dog is stabilized, it is possible to usually take her home after a day or two. Diabetic dogs must be very carefully monitored if taking prednisone that ought to only be given in life threatening ailments.


“Cyclosporin” redirects here. For other types of cyclosporin, see Cyclosporins.

Ciclosporin, also spelled cyclosporine and cyclosporin, is an immunosuppressant medication and natural product.[3] It is taken by mouth or by injection into a vein for rheumatoid arthritis, psoriasis, Crohn’s disease, nephrotic syndrome, and in organ transplants to prevent rejection.[3][4] It is also used as eye drops for keratoconjunctivitis sicca (dry eyes).[5]

Common side effects include high blood pressure, headache, kidney problems, increased hair growth, and vomiting.[4] Other severe side effects include an increased risk of infection, liver problems, and an increased risk of lymphoma.[4] Blood levels of the medication should be checked to decrease the risk of side effects.[4] Use during pregnancy may result in preterm birth; however, ciclosporin does not appear to cause birth defects.[6]

Ciclosporin is believed to work by decreasing the function of lymphocytes.[4] It does this by forming a complex with cyclophilin to block the phosphatase activity of calcineurin, which in turn decreases the production of inflammatory cytokines by T‐lymphocytes.[7]

Ciclosporin was isolated in 1971 from the fungus Tolypocladium inflatum and came into medical use in 1983.[8] It is on the World Health Organization’s List of Essential Medicines, the most effective and safe medicines needed in a health system.[9] The wholesale cost in the developing world is about US$106.50 a month.[10] In the United Kingdom, it costs the NHS about GB£121.25 per month.[11] The wholesale price in the United States is about US$172.95 per month.[12]


  • 1 Medical uses
  • 2 Side effects
  • 3 Pharmacology
    • 3.1 Mechanism of action
    • 3.2 Pharmacokinetics
  • 4 Biosynthesis
  • 5 History
  • 6 Society and culture
    • 6.1 Name
    • 6.2 Available forms
  • 7 Research
    • 7.1 Neuroprotection
    • 7.2 Cardiac disease
  • 8 Veterinary use
  • 9 See also
  • 10 References
  • 11 External links

Medical uses[edit]

Ciclosporin is approved by the FDA to treat and prevent graft-versus-host disease in bone marrow transplantation and to prevent rejection of kidney, heart, and liver transplants.[13][14] It is also approved in the US for treating of rheumatoid arthritis and psoriasis, persistent nummular keratitis following adenoviral keratoconjunctivitis,[15][14] and as eye drops for treating dry eyes caused by Sjögren’s syndrome and meibomian gland dysfunction.[16]

In addition to these indications, ciclosporin is also used in severe atopic dermatitis, Kimura disease, pyoderma gangrenosum, chronic hives, acute systemic mastocytosis, and posterior or intermediate uveitis with noninfective cause.[citation needed] It is also used, albeit infrequently, in severe rheumatoid arthritis and related diseases.[citation needed]

Ciclosporin has also been used in people with acute severe ulcerative colitis and hives that do not respond to treatment with steroids.[17]

Side effects[edit]

Side effects of ciclosporin can include gum enlargement, increased hair growth, convulsions, peptic ulcers, pancreatitis, fever, vomiting, diarrhea, confusion, increased cholesterol, trouble breathing, numbness and tingling (particularly of the lips), itchiness, high blood pressure, potassium retention (possibly leading to hyperkalemia), kidney and liver dysfunction,[18] burning sensations at finger tips, and an increased vulnerability to opportunistic fungal and viral infections. Ciclosporin causes hypertension by inducing vasoconstriction in the kidneys and increasing sodium reabsorption. The increase in blood pressure can cause cardiovascular events; it is thus recommended that the lowest effective dose for people requiring long-term treatment be used.[19]

Ciclosporin use after a kidney transplantation is associated with increased levels of uric acid in the blood and, in some cases, gout.[20] This is due to the decrease in glomerular filtration rate,[citation needed] which leads to uric acid retention. Use of azathioprine as an alternative has shown to reduce the incidence of gouty arthritis.

Ciclosporin is listed as an IARC Group 1 carcinogen (i.e. there is sufficient evidence of carcinogenicity in humans),[21] specifically leading to squamous cell skin cancer and non-Hodgkin lymphoma.[22]


Mechanism of action[edit]

Ciclosporin’s main effect is to lower the activity of T-cells; it does so by calcineurin–phosphatase pathway and preventing the mitochondrial permeability transition pore from opening. Ciclosporin binds to the cytosolic protein cyclophilin (immunophilin) of lymphocytes, especially of T cells. This ciclosporin—cyclophilin complex inhibits calcineurin, which is normally responsible for activating the transcription of interleukin 2. In T-cells, activation of the T-cell receptor normally increases intracellular calcium, which acts via calmodulin to activate calcineurin. Calcineurin then dephosphorylates the transcription factor NF-AT (nuclear factor of activated T-cells), which moves to the T-cell nucleus and increases the transcription of genes for IL-2 and related cytokines.[7] Ciclosporin, by preventing the dephosphorylation of NF-AT, leads to reduced effector T-cell function;[23][24][25][26] it does not affect cytostatic activity.

Ciclosporin also binds to the cyclophilin D protein that constitutes part of the mitochondrial permeability transition pore (MPTP).[24][27] The MPTP is found in the mitochondrial membrane of cardiac muscle cells and moves calcium ions (Ca2+
) into the mitochondria.[24][27] When open, Ca2+
enters the mitochondria and causes the muscle cells (and thus the heart) to contract. If unregulated, the influx of Ca2+
can contribute to mitochondrial swelling and dysfunction.[27]


Ciclosporin is a cyclic peptide of 11 amino acids; it contains a single D-amino acid, which is rarely encountered in nature. Unlike most peptides, ciclosporin is not synthesized by ribosomes.[28]

Ciclosporin is highly metabolized in humans and animals after ingestion. The metabolites, which include cyclosporin B, C, D, E, H, and L,[29] have less than 10% of ciclosporin’s immunosuppressant activity and are associated with higher kidney toxicity.[30] Individual ciclosporin metabolites have been isolated and characterized but do not appear to be extensively studied.


Cyclosporin biosynthesis. Bmt = butenyl-methyl-threonine, Abu = L-alpha-aminobutyric acid, Sar = sarcosine

Cyclosporin is synthesized by a nonribosomal peptide synthetase, cyclosporin synthetase.[31] The enzyme contains an adenylation domain, a thiolation domain, a condensation domain, and an N-methyltransferase domain. The adenylation domain is responsible for substrate recognition and activation, whereas the thiolation domain covalently binds the adenylated amino acids to phosphopantetheine, and the condensation domain elongates the peptide chain. Cyclosporin synthetase substrates include L-valine, L-leucine, L-alanine, glycine, 2-aminobutyric acid, 4-methylthreonine, and D-alanine, which is the starting amino acid in the biosynthetic process.[32] With the adenylation domain, cyclosporin synthetase generates the acyl-adenylated amino acids, then covalently binds the amino acid to phosphopantetheine through a thioester linkage. Some of the amino acid substrates become N-methylated by S-adenosyl methionine. The cyclization step releases cyclosporin from the enzyme.[33] Amino acids such as D-Ala and butenyl-methyl-L-threonine indicate cyclosporin synthetase requires the action of other enzymes such as a D-alanine racemase. The racemization of L-Ala to D-Ala is pyridoxal phosphate-dependent. The formation of butenyl-methyl-L-threonine is performed by a butenyl-methyl-L-threonine polyketide synthase that uses acetate/malonate as its starting material.[34]


In 1970, new strains of fungi were isolated from soil samples taken from Norway and from Wisconsin in the USA by employees of Sandoz (now Novartis) in Basel, Switzerland. Both strains produced a family of natural products called cyclosporins. Two related components that had antifungal activity were isolated from extracts from these fungi. The Norwegian strain, Tolypocladium inflatum Gams, was later used for the large scale fermentation of ciclosporin.[35]

The immunosuppressive effect of the natural product cyclosporin was discovered in December 1971 in a screening test on immune suppression designed and implemented by Hartmann F. Stähelin at Sandoz.[36][35] The chemical structure of cyclosporin was determined in 1976, also at Sandoz.[37][38] The success of the drug candidate ciclosporin in preventing organ rejection was shown in kidney transplants by R.Y. Calne and colleagues at the University of Cambridge,[39] and in liver transplants performed by Thomas Starzl at the University of Pittsburgh Hospital. The first patient, on 9 March 1980, was a 28-year-old woman.[40] In the United States, the Food and Drug Administration (FDA) approved ciclosporin for clinical use in 1983.[41][42][43][44]

Society and culture[edit]


The natural product was named cyclosporin by the German speaking scientists who first isolated it[35] and cyclosporine when translated into English. Per International Nonproprietary Name (INN) guidelines for drugs,[45] the “y” was replaced with “i” so that the INN for the medication is spelled ciclosporin.

Ciclosporin is the INN and British Approved Name (BAN), while cyclosporine is the United States Adopted Name (USAN) and cyclosporin is a former BAN.

Available forms[edit]

Ciclosporin exhibits very poor solubility in water, and, as a consequence, suspension and emulsion forms of the medication have been developed for oral administration and for injection. Ciclosporin was originally brought to market by Sandoz (now Novartis), under the brand name Sandimmune, which is available as soft gelatin capsules, an oral solution, and a formulation for intravenous administration. These are all nonaqueous compositions.[46] A newer microemulsion,[47] orally-administered formulation, Neoral,[48] is available as a solution and as soft gelatin capsules. The Neoral compositions are designed to form microemulsions in contact with water.

Generic ciclosporin preparations have been marketed under various trade names, including Cicloral (Sandoz/Hexal), Gengraf (Abbott) and Deximune (Dexcel Pharma). Since 2002, a topical emulsion of ciclosporin for treating inflammation caused by keratoconjunctivitis sicca (dry eye syndrome) has been marketed under the trade name Restasis (0.05%). Ikervis is a similar formulation with a concentration of 0.1%.[49] Inhaled ciclosporin formulations are in clinical development, and include a solution in propylene glycol and liposome dispersions.[50][51]



Ciclosporin is currently in a phase II/III (adaptive) clinical study in Europe to determine its ability to ameliorate neuronal cellular damage and reperfusion injury (phase III) in traumatic brain injury. This multi-center study is being organized by NeuroVive Pharma and the European Brain Injury Consortium using NeuroVive’s formulation of ciclosporin called NeuroSTAT (also known by its cardioprotection trade name of CicloMulsion). This formulation uses a lipid emulsion base instead of cremophor and ethanol.[52] NeuroSTAT was recently compared to Sandimmune in a phase I study and found to be bioequivalent. In this study, NeuroSTAT did not exhibit the anaphylactic and hypersensitivity reactions found in cremophor- and ethanol-based products.[53]

Ciclosporin has been investigated as a possible neuroprotective agent in conditions such as traumatic brain injury, and has been shown in animal experiments to reduce brain damage associated with injury.[54] Ciclosporin blocks the formation of the mitochondrial permeability transition pore, which has been found to cause much of the damage associated with head injury and neurodegenerative diseases. Ciclosporin’s neuroprotective properties were first discovered in the early 1990s when two researchers (Eskil Elmér and Hiroyuki Uchino) were conducting experiments in cell transplantation. An unintended finding was that CsA was strongly neuroprotective when it crossed the blood–brain barrier.[55] This same process of mitochondrial destruction through the opening of the MPT pore is implicated in making traumatic brain injuries much worse.[56]

Cardiac disease[edit]

Ciclosporin has been used experimentally to treat cardiac hypertrophy[24][57] (an increase in cell volume).

Inappropriate opening of the mitochondrial permeability transition pore (MPTP) manifests in ischemia[24] (blood flow restriction to tissue) and reperfusion injury[24] (damage occurring after ischemia when blood flow returns to tissue), after myocardial infarction[25] (heart attack) and when mutations in mitochondrial DNA polymerase occur.[24] The heart attempts to compensate for disease state by increasing the intracellular Ca2+
to increase the contractility cycling rates.[27] Constitutively high levels of mitochondrial Ca2+
cause inappropriate MPTP opening leading to a decrease in the cardiac range of function, leading to cardiac hypertrophy as an attempt to compensate for the problem.[27][25]

CsA has been shown to decrease cardiac hypertrophy by affecting cardiac myocytes in many ways. CsA binds to cyclophilin D to block the opening of MPTP, and thus decreases the release of protein cytochrome C, which can cause programmed cell death.[24][27][58] CypD is a protein within the MPTP that acts as a gate; binding by CsA decreases the amount of inappropriate opening of MPTP, which decreases the intramitochondrial Ca2+
.[27] Decreasing intramitochondrial Ca2+
allows for reversal of cardiac hypertrophy caused in the original cardiac response.[27] Decreasing the release of cytochrome C caused decreased cell death during injury and disease.[24] CsA also inhibits the phosphatase calcineurin pathway (14).[24][25][59] Inhibition of this pathway has been shown to decrease myocardial hypertrophy.[25][57][59]

Veterinary use[edit]

The medication is approved in the United States for the treatment of atopic dermatitis in dogs.[60] Unlike the human form of the medication, the lower doses used in dogs mean the drug acts as an immunomodulator and has fewer side effects than in humans. The benefits of using this product include the reduced need for concurrent therapies to bring the condition under control. It is available as an ophthalmic ointment for dogs called Optimmune, manufactured by Intervet, which is part of Merck. It is also used to treat sebaceous adenitis (immune response against the sebaceous glands), pemphigus foliaceus (autoimmune blistering skin disease), Inflammatory bowel disease, anal furunculosis (anal inflammatory disease), and myasthenia gravis (a neuromuscular disease).[60][61]

It is sometimes prescribed for extreme cases of immune-mediated hemolytic anemia.[61]

See also[edit]

  • Cremophor EL (additive in Sandimmune)
  • Castor oil (additive in Sandimmune)
  • Ethanol (additive in Sandimmune and Neoral)
  • Voclosporin, an analog of ciclosporin


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    Some sources list the fungus under an alternative species name Hypocladium inflatum gams such as Pritchard and Sneader in 2005:
    * Pritchard DI (May 2005). “Sourcing a chemical succession for cyclosporin from parasites and human pathogens”. Drug Discovery Today. 10 (10): 688–91. doi:10.1016/S1359-6446(05)03395-7. PMID 15896681. 
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  • ^ Heusler K, Pletscher A (June 2001). “The controversial early history of cyclosporin”. Swiss Medical Weekly. 131 (21–22): 299–302. PMID 11584691. Archived from the original on 2017-09-02. 
  • ^ Calne RY, White DJ, Thiru S, Evans DB, McMaster P, Dunn DC, Craddock GN, Pentlow BD, Rolles K (1978). “Cyclosporin A in patients receiving renal allografts from cadaver donors”. The Lancet. 2 (8104–5): 1323–7. doi:10.1016/S0140-6736(78)91970-0. PMID 82836. 
  • ^ Starzl TE, Klintmalm GB, Porter KA, Iwatsuki S, Schröter GP (July 1981). “Liver transplantation with use of cyclosporin a and prednisone”. The New England Journal of Medicine. 305 (5): 266–9. doi:10.1056/NEJM198107303050507. PMC 2772056 . PMID 7017414. 
  • ^ Kolata G (September 1983). “FDA speeds approval of cyclosporin”. Science. 221 (4617): 1273. doi:10.1126/science.221.4617.1273-a. PMID 17776314. On 2 September (1983), the Food and Drug Administration approved cyclosporin, a new drug that suppresses the immune system. 
  • ^ Gottesman J (20 March 1988). “Milestones in Cardiac Care”. Los Angeles Times. Archived from the original on 26 February 2017. 
  • ^ “First Successful Pediatric Heart Transplant [9 June 1984]”. Columbia University Medical Center, Dept. of Surgery, Cardiac Transplant Program. Archived from the original on 1 March 2017. It [cyclosporine] gained FDA approval at the end of 1983, … 
  • ^ “Drugs@FDA: FDA Approved Drug Products [Click on “Approval Date(s) and History]”. United States Food and Drug Administration. Archived from the original on 2017-03-01. Drug Name(s): Sandimmune (Cyclosporine), Company: Novartis, Action Date: 11/14/1983, Action Type: Approval, Submission Classification: Type 1 – New Molecular Entity, Review Priority: Priority 
  • ^ “Guidelines on the Use of International Nonproprietary Names (INNs) for Pharmaceutical Substances”. World Health Organization. 1997. To facilitate the translation and pronunciation of INN, “f” should be used instead of “ph”, “t” instead of “th”, “e” instead of “ae” or “oe”, and “i” instead of “y”; the use of the letters “h” and “k” should be avoided. 
  • ^ Sandimmune Prescribing Information Archived 2004-07-19 at the Wayback Machine.
  • ^ Gibaud S, Attivi D (August 2012). “Microemulsions for oral administration and their therapeutic applications”. Expert Opinion on Drug Delivery. 9 (8): 937–51. doi:10.1517/17425247.2012.694865. PMID 22663249. 
  • ^ Neoral Prescribing Information Archived 2007-07-28 at the Wayback Machine.
  • ^ “Ikervis”. Santen. Retrieved 2018-07-03. 
  • ^ Clinical trial number NCT01287078 for “Cyclosporine Inhalation Solution (CIS) in Lung Transplant and Hematopoietic Stem Cell Transplant Recipients for the Treatment of Bronchiolitis Obliterans” at ClinicalTrials.gov.
  • ^ Trammer, B; Amann, A; Haltner-Ukomadu, E; Tillmanns, S; Keller, M; Högger, P (Nov 2008). “Comparative permeability and diffusion kinetics of cyclosporine A liposomes and propylene glycol solution from human lung tissue into human blood ex vivo”. Eur J Pharm Biopharm. 70 (3): 758–64. doi:10.1016/j.ejpb.2008.07.001. 
  • ^ Administrator. “Hem – NeuroVive Pharmaceutical AB”. neurovive.com. Archived from the original on 2014-01-06. 
  • ^ Ehinger KH, Hansson MJ, Sjövall F, Elmér E (January 2013). “Bioequivalence and tolerability assessment of a novel intravenous ciclosporin lipid emulsion compared to branded ciclosporin in Cremophor ® EL”. Clinical Drug Investigation. 33 (1): 25–34. doi:10.1007/s40261-012-0029-x. PMC 3586182 . PMID 23179472. 
  • ^ Sullivan PG, Thompson M, Scheff SW (February 2000). “Continuous infusion of cyclosporin A postinjury significantly ameliorates cortical damage following traumatic brain injury”. Experimental Neurology. 161 (2): 631–7. doi:10.1006/exnr.1999.7282. PMID 10686082. 
  • ^ Uchino H, Elmér E, Uchino K, Lindvall O, Siesjö BK (December 1995). “Cyclosporin A dramatically ameliorates CA1 hippocampal damage following transient forebrain ischaemia in the rat”. Acta Physiologica Scandinavica. 155 (4): 469–71. doi:10.1111/j.1748-1716.1995.tb09999.x. PMID 8719269. 
  • ^ Sullivan PG, Sebastian AH, Hall ED (February 2011). “Therapeutic window analysis of the neuroprotective effects of cyclosporine A after traumatic brain injury”. Journal of Neurotrauma. 28 (2): 311–8. doi:10.1089/neu.2010.1646. PMC 3037811 . PMID 21142667. 
  • ^ a b Mende U, Kagen A, Cohen A, Aramburu J, Schoen FJ, Neer EJ (November 1998). “Transient cardiac expression of constitutively active Galphaq leads to hypertrophy and dilated cardiomyopathy by calcineurin-dependent and independent pathways”. Proceedings of the National Academy of Sciences of the United States of America. 95 (23): 13893–8. doi:10.1073/pnas.95.23.13893. PMC 24952 . PMID 9811897. 
  • ^ Wilkinson ST, Johnson DB, Tardif HL, Tome ME, Briehl MM (March 2010). “Increased cytochrome c correlates with poor survival in aggressive lymphoma”. Oncology Letters. 1 (2): 227–230. doi:10.3892/ol_00000040. PMC 2927837 . PMID 20798784. 
  • ^ a b Lim HW, De Windt LJ, Mante J, Kimball TR, Witt SA, Sussman MA, Molkentin JD (April 2000). “Reversal of cardiac hypertrophy in transgenic disease models by calcineurin inhibition”. Journal of Molecular and Cellular Cardiology. 32 (4): 697–709. doi:10.1006/jmcc.2000.1113. PMID 10756124. 
  • ^ a b Archer TM, Boothe DM, Langston VC, Fellman CL, Lunsford KV, Mackin AJ (2014). “Oral cyclosporine treatment in dogs: a review of the literature”. Journal of Veterinary Internal Medicine. 28 (1): 1–20. doi:10.1111/jvim.12265. PMC 4895546 . PMID 24341787. 
  • ^ a b Palmeiro BS (January 2013). “Cyclosporine in veterinary dermatology”. Veterinary Clinics of North America: Small Animal Practice. 43 (1): 153–71. doi:10.1016/j.cvsm.2012.09.007. PMID 23182330. 
  • External links[edit]

    • Cyclosporine at the US National Library of Medicine Medical Subject Headings (MeSH)
    • U.S. National Library of Medicine: Drug Information Portal — Cyclosporine
    • ChemSub Online : Cyclosporin A
    • Neoral U.S. Prescribing Information
    • Restasis brand
    • Sandimmune U.S. Prescribing Information




    • Anti-thymocyte globulin
    • Anti-lymphocyte globulin

    -cept (Fusion)

    • CTLA-4
      • Abatacept
      • Belatacept
    • TNF inhibitor
      • Etanercept
      • Pegsunercept
    • Aflibercept
    • Alefacept
    • Rilonacept
    • Pharmacy and pharmacology portal
    • Medicine portal

    Source: https://en.wikipedia.org/wiki/Ciclosporin

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    Cetirizine, prominently marketed under the brand name Zyrtec among others, is a potent second-generation antihistamine used in the treatment of hay fever, allergies, angioedema, and urticaria.[5] It acts as a selective antagonist of the histamine H1 receptor.

    Second-generation antihistamines like cetirizine are less able to cross the blood–brain barrier and therefore have diminished effects on the central nervous system compared to first-generation drugs. As such, they are less likely to cause drowsiness or memory impairment.


    • 1 Medical uses
      • 1.1 Allergies
      • 1.2 Rhinovirus infection
      • 1.3 Kimura’s disease
      • 1.4 Available forms
    • 2 Adverse effects
      • 2.1 Withdrawal
    • 3 Pharmacology
      • 3.1 Pharmacodynamics
      • 3.2 Pharmacokinetics
        • 3.2.1 Absorption
        • 3.2.2 Distribution
        • 3.2.3 Metabolism
        • 3.2.4 Elimination
    • 4 Chemistry
      • 4.1 Synthesis
    • 5 Society and culture
      • 5.1 Brand names
      • 5.2 Availability
    • 6 References
      • 6.1 Books and journals
    • 7 External links

    Medical uses[edit]


    Cetirizine’s primary indication is for hay fever and other allergies. Because the symptoms of itching and redness in these conditions are caused by histamine acting on the H1 receptor, blocking those receptors temporarily relieves those symptoms.

    Cetirizine is also commonly prescribed to treat acute and (in particular cases) chronic urticaria, more efficiently than any other second-generation antihistamine[citation needed].

    Rhinovirus infection[edit]

    Interleukin 6 and interleukin 8 have been shown to be elevated in acute respiratory distress syndrome.[6] One recent study of airway epithelial cells showed that levocetirizine, the active enantiomer of cetirizine, may have beneficial effects on the pathophysiologic changes related to human rhinovirus (HRV) infection.[7]

    Kimura’s disease[edit]

    Cetirizine is an effective agent in treating the symptoms of Kimura’s disease which predominantly affects the lymph nodes and soft tissue of the head and neck in the form of tumor-like lesions. Cetirizine’s properties of being effective both in the treatment of pruritus (itching) and as an anti-inflammatory agent make it suitable for the treatment of the pruritus associated with these lesions.[8] In a 2005 study, the American College of Rheumatology conducted treatments initially using prednisone, followed by steroid dosages and azathioprine, omeprazole, and calcium and vitamin D supplements over the course of two years.[8] The skin condition of the patient began to improve and the skin lesions lessened. However, there were symptoms of cushingoid and hirsutism observed before the patient was removed from the courses of steroids and placed on 10 mg/day of cetirizine to prevent skin lesions;[8] an agent suitable for the treatment of pruritus associated with such lesions.[8] Asymptomatically, the patient’s skin lesions disappeared after treatment with cetirizine, blood eosinophil counts became normal,[8] corticosteroid effects were resolved,[8] and a remission began within a period of two months.[8] It is also thought that the inhibition of eosinophils may be the key to treatment of Kimura’s disease due to the role of eosinophils, rather than other cells with regards to the lesions of the skin.[8]

    Available forms[edit]

    Cetirizine is available over-the-counter in the form of 5 and 10 mg tablets. A 20mg strength is available by prescription only.[1]

    Adverse effects[edit]

    Commonly reported side effects of cetirizine include headache (16%), dry mouth (5.7%), drowsiness (5–20%), and fatigue (5.6%), while more serious but rare side effects include cardiac failure, tachycardia, and edema.[9]


    A 2016 study published in Drug Safety suggests “a causal relation between withdrawal of (levo)cetirizine and the occurrence of unbearable pruritus”, concluding that “healthcare professionals should be aware that in some patients this reaction can occur.” Patients studied were found to have been using cetirizine continuously for months or years.[10]

    Long-term daily usage of cetirizine may result in what resembles antihistamine dependency. No official study has been conducted to determine how long a patient may take cetirizine daily before expecting to encounter withdrawal symptoms when treatment stops. Many patients seeking help with withdrawal symptoms report having taken cetirizine for more than three years, while others report having taken it for no longer than one week.[11][12]

    Insatiable, generalized itching is the most commonly-reported withdrawal side effect, though others have reported severe rebound of original, pre-treatment systems as well, including sneezing and runny nose.[13][14]


    L-Stereoisomer, levocetirizine (top) and D-stereoisomer of cetirizine.


    Cetirizine acts as a highly selective antagonist of the histamine H1 receptor.[1] The Ki values for the H1 receptor are approximately 6 nM for cetirizine, 3 nM for levocetirizine, and 100 nM for dextrocetirizine, indicating that the levorotatory enantiomer is the main active form.[1] Cetirizine has 600-fold or greater selectivity for the H1 receptor over a wide variety of other sites, including muscarinic acetylcholine, serotonin, dopamine, and α-adrenergic receptors, among many others.[1] The drug shows 20,000-fold or greater selectivity for the H1 receptor over the five muscarinic acetylcholine receptors, and hence does not exhibit anticholinergic effects.[15][16] It shows negligible inhibition of the hERG channel (IC50 > 30 µM)[17] and no cardiotoxicity has been observed with cetirizine at doses of up to 60 mg/day, six times the normal recommended dose[1] and the highest dose of cetirizine that has been studied in healthy subjects.[18]

    Cetirizine crosses the blood–brain barrier only slightly, and for this reason, it produces minimal sedation compared to many other antihistamines.[19] A positron emission tomography (PET) study found that brain occupancy of the H1 receptor was 12.6% for 10 mg cetirizine, 25.2% for 20 mg cetirizine, and 67.6% for 30 mg hydroxyzine.[20] (A 10 mg dose of cetirizine equals about a 30 mg dose of hydroxyzine in terms of peripheral antihistamine effect.)[21] PET studies with antihistamines have found that brain H1 receptor occupancy of more than 50% is associated with a high prevalence of somnolence and cognitive decline, whereas brain H1 receptor occupancy of less than 20% is considered to be non-sedative.[22] In accordance, H1 receptor occupancy correlated well with subjective sleepiness for 30 mg hydroxyzine but there was no correlation for 10 or 20 mg cetirizine.[20] As such, brain penetration and brain H1 receptor occupancy by cetirizine are dose-dependent, and in accordance, while cetirizine at doses of 5 to 10 mg have been reported to be non-sedating or mildly sedating, a higher dose of 20 mg has been found to induce significant drowsiness in other studies.[20]

    Cetirizine has been shown to inhibit eosinophil chemotaxis and LTB4 release.[23] At a dosage of 20 mg, Boone et al. found that it inhibited the expression of VCAM-1 in patients with atopic dermatitis.[23]



    Cetirizine is rapidly and extensively absorbed upon oral administration in tablet or syrup form.[1] The oral bioavailability of cetirizine is at least 70% and of levocetirizine is at least 85%.[3] The Tmax of cetirizine is approximately 1.0 hour regardless of formulation and its onset of action has been reported to be as early as 20 minutes.[2] The pharmacokinetics of cetirizine have been found to increase linearly with dose across a range of 5 to 60 mg.[1] Its Cmax following a single dose has been found to be 257 ng/mL for 10 mg and 580 ng/mL for 20 mg.[2] Food has no effect on the bioavailability of cetirizine but has been found to delay the Tmax by 1.7 hours (i.e., to approximately 2.7 hours) and to decrease the Cmax by 23%.[1][2][24] Similar findings were reported for levocetirizine, which had its Tmax delayed by 1.25 hours and its Cmax decreased by about 36% when administered with a high-fat meal.[24] Steady-state levels of cetirizine occur within 3 days and there is no accumulation of the drug with chronic administration.[2] Following once-daily administration of 10 mg cetirizine for 10 days, the mean Cmax was 311 ng/mL.[25]


    The mean plasma protein binding of cetirizine has been found to be 93 to 96% across a range of 25 to 1,000 ng/mL independent of concentration.[2] Plasma protein binding of 88 to 96% has also been reported across multiple studies.[3] The drug is bound to albumin with high affinity, while α1-acid glycoprotein and lipoproteins contribute much less to total plasma protein binding.[3] The unbound or free fraction of levocetirizine has been reported to be 8%.[3] The true volume of distribution of cetirizine is unknown but is estimated to be 0.3 to 0.45 L/kg.[1][3] Cetirizine poorly and slowly crosses the blood–brain barrier, which is due mainly to its chemical properties but also to a minor extent to its activity as a P-glycoprotein substrate.[3]


    Cetirizine does not undergo extensive metabolism.[1] It is notably not metabolized by the cytochrome P450 system.[26] Because of this, it does not interact significantly with drugs that inhibit or induce cytochrome P450 enzymes such as theophylline, erythromycin, clarithromycin, cimetidine, or alcohol.[1] While cetirizine does not undergo extensive metabolism or metabolism by the cytochrome P450 enzyme, it does undergo some metabolism by other means, the metabolic pathways of which include oxidation and conjugation.[1][2] Plasma radioactivity attributed to unchanged cetirizine is more than 90% at 2 hours, 80% at 10 hours, and 70% at 24 hours, indicating limited and slow metabolism.[2] The enzymes responsible for transformation of cetirizine have not been identified.[1]


    Cetirizine is eliminated approximately 70 to 85% in the urine and 10 to 13% in the feces.[1] About 50 or 60% of cetirizine eliminated in the urine is unchanged.[1][2] It is eliminated in the urine via an active transport mechanism.[2] The elimination half-life of cetirizine ranges from 6.5 to 10 hours in healthy adults, with a mean across studies of approximately 8.3 hours.[1][2] Its duration of action is at least 24 hours.[2] The elimination half-life of cetirizine is increased in the elderly (to 12 hours), in hepatic impairment (to 14 hours), and in renal impairment (to 20 hours).[2]


    Cetirizine contains L- and D-stereoisomers. Chemically, levocetirizine is the active L-enantiomer of cetirizine. The drug is a member of the diphenylmethylpiperazine group of antihistamines. Analogues include cyclizine and hydroxyzine.


    Cetirizine synthesis:[27]

    The 1-[(4-chlorophenylmethyl]-piperazine is alkylated with methyl (2-chloroethoxy)-acetate in the presence of sodium carbonate and xylene solvent to produce the Sn2 substitution product in 28% yield. Saponification of the acetate ester is done by refluxing with potash in absolute ethanol to afford a 56% yield of the potassium salt intermediate. This is then hydrolyzed with aqueous HCl and extracted to give an 81% yield of the carboxylic acid product.

    Society and culture[edit]

    A package of 10 mg cetirizine tablets.

    Zyrtec-D, a combination of cetirizine and pseudoephedrine.

    Brand names[edit]

    Cetirizine is marketed under the brand names Alatrol, Alerid, Alzene, Cetirin, Cetzine, Cezin, Histazine, Humex, Letizen, Reactine, Razene, Rigix, Triz, Zetop, Zirtec, Zirtek, Zodac, Zyllergy, Zynor, Zyrlek, and Zyrtec among others.


    Formerly prescription-only in many countries, cetirizine is now available without prescription in most countries. In some countries it is available over-the-counter only in packages containing seven or ten 10 mg doses.

    Like many other antihistamine medications, cetirizine is commonly prescribed in combination with pseudoephedrine, a decongestant. These combinations are often marketed using the same brand name as the cetirizine with a “-D” suffix (Zyrtec-D, Virlix-D, etc.)


  • ^ a b c d e f g h i j k l m n o p q r s t Portnoy JM, Dinakar C (2004). “Review of cetirizine hydrochloride for the treatment of allergic disorders”. Expert Opin Pharmacother. 5 (1): 125–35. doi:10.1517/14656566.5.1.125. PMID 14680442. 
  • ^ a b c d e f g h i j k l m n o Simons FE, Simons KJ (1999). “Clinical pharmacology of new histamine H1 receptor antagonists”. Clin Pharmacokinet. 36 (5): 329–52. doi:10.2165/00003088-199936050-00003. PMID 10384858. 
  • ^ a b c d e f g h Chen C (2008). “Physicochemical, pharmacological and pharmacokinetic properties of the zwitterionic antihistamines cetirizine and levocetirizine”. Curr. Med. Chem. 15 (21): 2173–91. doi:10.2174/092986708785747625. PMID 18781943. 
  • ^ a b Simons FE (2002). “Comparative pharmacology of H1 antihistamines: clinical relevance”. Am. J. Med. 113 Suppl 9A: 38S–46S. doi:10.1016/s0002-9343(02)01436-5. PMID 12517581. 
  • ^ “Medscape Log In”. 
  • ^ Chollet-Martin S, Montravers P, Gibert C, Elbim C, Desmonts JM, Fagon JY, Gougerot-Pocidalo MA (November 1993). “High levels of interleukin-8 in the blood and alveolar spaces of patients with pneumonia and adult respiratory distress syndrome”. Infection and Immunity. 61 (11): 4553–9. PMC 281204 . PMID 8406851. 
  • ^ Jang YJ, Wang JH, Kim JS, Kwon HJ, Yeo NK, Lee BJ (March 2009). “Levocetirizine inhibits rhinovirus-induced ICAM-1 and cytokine expression and viral replication in airway epithelial cells”. Antiviral Research. 81 (3): 226–33. doi:10.1016/j.antiviral.2008.12.001. PMID 19110001. 
  • ^ a b c d e f g h Ben-Chetrit E, Amir G, Shalit M (February 2005). “Cetirizine: An effective agent in Kimura’s disease”. Arthritis Rheum. 53 (1): 117–8. doi:10.1002/art.20908. PMID 15696573. 
  • ^ “Zyrtec Side Effects”. drugs.com. Drugs.com. Retrieved 21 August 2015. 
  • ^ Ekhart C, van der Horst P, van Hunsel F (December 2016). “Unbearable Pruritus After Withdrawal of (Levo)cetirizine”. Drug Safety – Case Reports. 3 (1): 16. doi:10.1007/s40800-016-0041-9. PMC 5124431 . PMID 27889900. 
  • ^ “Zyrtec Withdrawal Is a Nightmare”. People’s Pharmacy. Retrieved 9 September 2017. 
  • ^ “Itching Withdrawal From Cetirizine Or Zyrtec”. MedsChat.com. Retrieved 9 September 2017. 
  • ^ “Cetirizine (Zyrtec) Withdrawal & Unbearable Itching”. People’s Pharmacy. Retrieved 9 September 2017. 
  • ^ “addicted to zyrtec?”. MedHelp. Retrieved 9 September 2017. 
  • ^ Zhang L, Cheng L, Hong J (2013). “The clinical use of cetirizine in the treatment of allergic rhinitis”. Pharmacology. 92 (1–2): 14–25. doi:10.1159/000351843. PMID 23867423. 
  • ^ Orzechowski RF, Currie DS, Valancius CA (2005). “Comparative anticholinergic activities of 10 histamine H1 receptor antagonists in two functional models”. Eur. J. Pharmacol. 506 (3): 257–64. doi:10.1016/j.ejphar.2004.11.006. PMID 15627436. 
  • ^ Taglialatela M, Pannaccione A, Castaldo P, Giorgio G, Zhou Z, January CT, Genovese A, Marone G, Annunziato L (1998). “Molecular basis for the lack of HERG K+ channel block-related cardiotoxicity by the H1 receptor blocker cetirizine compared with other second-generation antihistamines”. Mol. Pharmacol. 54 (1): 113–21. doi:10.1124/mol.54.1.113. PMID 9658196. 
  • ^ Hulhoven R, Rosillon D, Letiexhe M, Meeus MA, Daoust A, Stockis A (2007). “Levocetirizine does not prolong the QT/QTc interval in healthy subjects: results from a thorough QT study”. Eur. J. Clin. Pharmacol. 63 (11): 1011–7. doi:10.1007/s00228-007-0366-5. PMID 17891537. The equivalent dose of 60 mg cetirizine is also the highest dose ever administered in healthy subjects [13]. 
  • ^ Gupta, A; Chatelain P; Massingham R; Jonsson EN; Hammarlund-Udenaes M (February 2006). “Brain distribution of cetirizine enantiomers: comparison of three different tissue-to-plasma partition coefficients: K(p), K(p,u), and K(p,uu)”. Drug Metab. Dispos. 34 (2): 318–23. doi:10.1124/dmd.105.007211. PMID 16303872. 
  • ^ a b c Tashiro M, Kato M, Miyake M, Watanuki S, Funaki Y, Ishikawa Y, Iwata R, Yanai K (2009). “Dose dependency of brain histamine H(1) receptor occupancy following oral administration of cetirizine hydrochloride measured using PET with [11C]doxepin”. Hum Psychopharmacol. 24 (7): 540–8. doi:10.1002/hup.1051. PMID 19697300. 
  • ^ van den Elzen MT, van Os-Medendorp H, van den Brink I, van den Hurk K, Kouznetsova OI, Lokin AS, Laheij-de Boer AM, Röckmann H, Bruijnzeel-Koomen CA, Knulst AC (2017). “Effectiveness and safety of antihistamines up to fourfold or higher in treatment of chronic spontaneous urticaria”. Clin Transl Allergy. 7: 4. doi:10.1186/s13601-017-0141-3. PMC 5309999 . PMID 28289538. […] 30 mg of hydroxyzine equals about 10 mg cetirizine [11] […] 
  • ^ Yanai K, Tashiro M (2007). “The physiological and pathophysiological roles of neuronal histamine: an insight from human positron emission tomography studies”. Pharmacol. Ther. 113 (1): 1–15. doi:10.1016/j.pharmthera.2006.06.008. PMID 16890992. 
  • ^ a b Boone M, Lespagnard L, Renard N, Song M, Rihoux JP (July 2000). “Adhesion molecule profiles in atopic dermatitis vs. allergic contact dermatitis: pharmacological modulation by cetirizine”. J Eur Acad Dermatol Venereol. 14 (4): 263–6. doi:10.1046/j.1468-3083.2000.00017.x. PMID 11204513. Retrieved 19 November 2009. 
  • ^ a b Paśko P, Rodacki T, Domagała-Rodacka R, Palimonka K, Marcinkowska M, Owczarek D (2017). “Second generation H1 – antihistamines interaction with food and alcohol-A systematic review”. Biomed. Pharmacother. 93: 27–39. doi:10.1016/j.biopha.2017.06.008. PMID 28622592. 
  • ^ “Zyrtec prescribing information” (PDF). May 2006. Archived from the original (PDF) on 4 January 2010. Retrieved 19 November 2009. 
  • ^ Massoud Mahmoudi (2 June 2016). Allergy and Asthma: Practical Diagnosis and Management. Springer. pp. 574–. ISBN 978-3-319-30835-7. 
  • ^ US patent 4525358, Baltes E, De Lannoy J, Rodriguez L, “2-[4-(Diphenylmethyl)-1-piperazinyl]-acetic acids and their amides”, issued 25 June 1985, assigned to UCB Pharmaceuticals, Inc. 
  • Books and journals[edit]

  • Anderson, P. O., Knoben, J. E., et al. (2002) Handbook of clinical drug data 10th ed. McGraw-Hill International
  • Pfizer Inc., et al. (2006) ZYRTEC (cetirizine hydrochloride) Tablets, Chewable Tablets and Syrup For Oral Use Pfizer Incorporated publications
  • Chetrit, E. B., Amir, G., Shalit, M. (2005). Cetirizine: an effective agent in Kimura’s Disease Arthritis & Rheumatism (Arthritis care & research) Vol 53, p117-118
  • External links[edit]

    • U.S. National Library of Medicine: Drug Information Portal – Cetirizine


    See also
    Receptor/signaling modulators

    Source: https://en.wikipedia.org/wiki/Cetirizine

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