Cyclosporine Absorption in Two Patients with Short-Bowel Syndrome

Abstract

We present the cases of two patients with short-bowel syndrome who failed to achieve therapeutic cyclosporine serum concentrations on oral drug but were successful on intravenous administration. One patient received cyclosporine after renal transplantation for renal failure secondary to enteric oxalosis; the second received cyclosporine for active Crohn's disease. The rapid bowel transit time was the critical factor in limiting cyclosporine absorption in both cases. In studying oral and intravenous pharmacokinetic profiles, we support a zero-order kinetic model for oral cyclosporine absorption.

Pharmacokinetics of tacrolimus and cyclosporine in short-bowel syndrome

“…These yielded undetectable cyclosporine blood concentrations in 1 patient, despite very high doses, and only 3% bioavailability in the other. 9 Similarly, our patient had negligible absorption of Sandimmune, and it was obviously not a therapeutic option in this patient.…”

Long-Term Outcome of Living Related Renal Transplantation in a Patient with Short Bowel Syndrome

“…Oral administration of tacrolimus provided an effective level of immunosuppression after liver transplantation in some patients with SBS (Novelli et al 1999;Olio et al 2006). As for cyclosporine, successful immunosuppression was attained in two patients with SBS by intravenous but not oral administration (Roberts et al 1988). Further information was available from a pharmacokinetic study (Thielke et al 1988).…”

Short small bowel in children. Complications and treatment strategies

“…A therapeutic serum concentration was achieved after intravenous administration, but both cases failed to achieve therapeutic cyclosporine serum concentrations after oral administration. The critical limiting factor in cyclosporine absorption in both cases was the rapid intestinal transit time [74].…”