Matthew J. Zirwas, MD
- Prednisone is drug of choice for expected short term therapy – weeks.
- Cyclosporine is drug of choice for expected “medium term therapy” – months.
- Methotrexate is drug of choice for chronic therapy in patients without liver, kidney, or hematologic co-morbidities.
- Mycophenolate is drug of choice for chronic therapy in patients with liver, kidney, or hematologic co-morbidities.
- Cyclosporine has many drug interactions – must use a computerized drug interaction checker.
- Methotrexate has a few drug interactions but they are extremely serious and can be fatal.
- Mycophenolate has few drug interactions.
- Patients on methotrexate should take folic acid on days they do not take the methotrexate.
- Older patients on mycophenolate, in particular, are at high risk of zoster.
- If patients on cyclosporine have elevations in creatinine, they need to stop the medication.
