Indications & Dose: KERATOCONJUNCTIVITIS SICCA-ASSOCIATED OCULAR INFLAMMATION TP Adult Instill 1 drop in each eye q12h Child > 16 yr: Same as adult dosein patients not already using topical anti-inflammatory drugs or punctual plugs | NEPHROTIC SYNDROME PO Child 1 month-18 yr: 3mg/kg BID, increase if necessary in corticosteroid-resistant disease, MD reduce to lowest effective dose according serum drug levels, proteinuria & renal function | PREVENTION OF ALLOGRAFT REJECTION PO Adult Conventional formulation: 15mg/kg given as single dose 4-12h before transplantation, low dose is required for renal allotransplantation. After transplantation, continue initial dose for 1-2 wk & taper by 5% every wk to a MD of 5-10mg/kg/day, in renal transplant patients 3mg/kg/day Child Same as adult dose | IV Adult Inf: Initially 5-6mg/kg/day or 1/3rd of oral dose as single dose over 2-6h, then switch to oral dosage as soon as possible | PSORIASIS PO Adult Initially 2.5mg/kg/day in 2 divided doses, if inadequate response after 4 wk then increase dose by 0.5mg/kg/day. Dose may be further increased to q2wk if needed, max 4mg/kg/day. Discontinue if no benefit is seen after 6 wk of therapy. Once patients are adequately controlled, reduce dose to the lowest effective dose (2.5mg/kg/day) Child 1 month-18 yr: Initially 1.25mg/kg BID, increased gradually to max 2.5mg/kg BID. Discontinue if no benefit is seen after 6 wk of therapy | RHEUMATOID ARTHRITIS PO Adult Initially 2.5mg/kg/day in 2 divided doses, may be increased by 0.5-0.75 mg/kg/day if insufficient response after 8 weeks of therapy, additional dosage may be increased at 12 wks, max 4mg/kg/day. Discontinue if no benefit is seen after 16 wks of therapy

Precautions: Use of IUCD, hyperuricemia, renal/hepatic impairment, live attenuated vaccines

ADR: Serious: MI, pancreatitis, glomerular capillary thrombosis, renal dysfunction, nephrotoxicity, thrombocytopenia, metabolic acidosis, anaphylaxis, leukopenia, upper GI bleeding, pneumocystis, jiroveci pneumonia, hyperuricemia, gynecomastia, tinnitus, triglycerides increased, HTN, tremor, visual disturbances, Others: hyperglycemia, hypomagnesemia, muscle & joint pain, dyspnea, hirsutism, gum hyperplasia, flu like symptoms, fever, weight loss, PUD, difficulty in swallowing, anorexia, hiccups, ocular burning, headache, confusion, paresthesia, insomnia, anxiety, depression

DDI: Serious Vaccines (Live)/HIV protease inhibitors antibody response decreased by drug, Digoxin clearance decreases, Lovastatin/CCBs clearance decreases leads to increases risk of rhabdomyolysis, Carbamazepine/Azathioprine/Cyclophosphamide/Phenobarbital/Phenytoin/Rifampicin/Ticlopidine decreases drug levels, Amiodarone/Allopurinol/Bromocriptine/Clarithromycin/Colchicine/Corticosteroids/Diltiazem/Erythromycin/Fluconazole/Verapamil increases drug levels, Aminoglycosides/Aciclovir/Amphotericin-B/Cimetidine/Diclofenac/Gentamicin/Ketoconazole/Melphalan/Naproxen/Ranitidine/Tacrolimus/Tobramycin/Vancomycin increases risk of nephrotoxicity, Spironolactone/Amiloride leads to hyperkalemia

Diet:

Monitor: BP, SeCr, serum electrolytes, renal function test, LFT, BP, lipid profile