Systemic Medications: Top Ten Take Home Points

Matthew J. Zirwas, MD 

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