A Prospective Study on Conversion from Sandimmune to Neoral in Stable Adult Liver Transplant Recipients

Neoral is a microemulsion formulation ofcyclosporin (CyA), which has more consistent and betterpharmacokinetics parameters with improvedbioavailability compared to conversional formulation ofSandimmune. Sixty-four stable adults (age >18 years),who had received liver transplants (LTx) and were onSandimmune-based immunosuppression, were converted toNeoral on milligram for milligram basis. Mean age was 52.5 ± 13.5 years and male/femaledistribution was 22/42. Mean interval from LTx toconversion was 109.2 ± 136 months. In 13 patients(20% ) the dose of Neoral was reduced because of anincrease in serum creatinine (N = 9), hyperkalemia (N =1), headache (N = 1), peripheral parasthesia (N = 1),and a general sense of discomfort (N = 1).Interestingly, in two patients a decrease in the troughconcentration was observed with the increase in liverenzymes. Both patients responded to an increase inNeoral dose. The present study suggests while themajority of the stable liver transplant patients (77%)can be safely converted to Neoral from Sandimmune ona milligram to milligram basis, they need to becarefully monitored for renal function, liver function,and trough concentration of CyA.