Immunosuppressive drugs or immunosuppressants are a class of drugs used to suppress or lower the immune system. This class of drugs is given to patients undergoing organ transplantation, for example in kidney or liver transplantation. In addition, immunosuppressant drugs are also used to treat a number of autoimmune diseases, such as:
- Rheumatoid arthritis, which is a chronic inflammation of the joints that causes pain, swelling, and stiffness.
- Psoriasis, which is chronic inflammation of the skin.
- Ankylosing spondylitis, namely inflammation of the spine.
- Chronic inflammation of the digestive tract, such as Crohn's disease and ulcerative colitis.
- Asthma.
- Nasal polyps.
In addition to suppressing the immune system when receiving new organs and overcoming autoimmune diseases, immunosuppressant drugs are also used in croup, a type of respiratory tract infection in children, as well as a form of therapy for kidney cancer.
The doctor will determine the type of immunosuppressive drug to be given by looking at the patient's condition, both in organ transplant patients and autoimmune diseases. The following are types of immunosuppressive drugs and examples:
- Mono antibodyklonal, such as basiliximab.
- Biology, examples are adalimumab, etanercept, golimumab, infliximab, secukinumab, and rituximab.
- Corticosteroids, Examples include budesonide, prednisone, and prednisolone.
- Inhibitor mammalian target of rapamycin (mTOR), For example, everolimus.
- Inhibitor calcineurin, Examples include ciclosporine and tacrolimus.
- Enzyme inhibitor inosine monophosphate dehydrogenase, Examples include azathioprine and mycophenolate.
Warning:
- Be careful when using immunosuppressant drugs if you have kidney problems, liver disease, severe or chronic infections, or a history of hepatitis B or C.
- Talk to your doctor first if you want to give this medicine to children.
- Tell your doctor if you are taking any other medicines, including supplements and products.
- If you experience an allergic reaction or overdose, see a doctor immediately.
Side Effects of Immunosuppressant Drugs
Side effects that can be experienced after using immunosuppressant drugs are severe infections. If you experience any of the side effects below, don't hesitate to visit your doctor so that your complaint can be handled appropriately:
- Fever or chills.
- Back pain.
- Difficult and painful when urinating.
- Feelings of weakness and fatigue that appear suddenly, for no apparent reason.
Types, Trademarks, and Dosage of Immunosuppressant Drugs
The following are the types of drugs that are included in the immunosuppressive drug class. To get a more detailed explanation of the side effects, warnings, or interactions of each drug, please see the A-Z Drugs page.
Basiliximab
Basiliximab trademark: Simulect
Drug form: intravenous injection
- Kidney transplant
Mature: The injection dose given is 20 mg, infusion over 20-30 minutes, given 2 hours before organ transplantation. Followed by a dose of 20 mg, 4 days after transplantation.
Children weighing < 35 kg: The injection dose given is 10 mg, infusion over 20-30 minutes, given 2 hours before surgery. The dose was repeated 4 days later after transplantation.
Children weighing > 35 kg: Same as the adult dose.
Adalimumab
Trademark: Humira
Drug form: Subcutaneous injection
- Rheumatoid arthritisMature: 40 mg, once a week.
- Ankylosing spondylitisMature: 40 mg, once a week.
- Crohn's disease and ulcerative colitis
Mature: The initial dose is 160 mg (given as 4 injections, 40 mg per day. Or 40 mg, 2 times daily, for 2 consecutive days. Then 80 mg is given on the 15th day.
- Arthritis in children
Children aged 4-15 years weighing < 30 kg: 20 mg per week.
Children aged 4-15 years weighing > 30 kg: 40 mg per week.
Etanercept
Trademark: Enbrel
Drug form: Subcutaneous injection
- psoriasisMature: The initial dose is 25 mg, 2 times a week. Or 50 mg, once a week.
Children aged six years and over: 0.8 mg/kg, once a week, for 6 months. Stop treatment if there is no change in condition during 12 weeks of drug use. The maximum dose is 50 mg per week.
- Arthritis in children
Children aged two years and over: 0.4 mg/kg body weight (maximum 25 mg), 2 times a week, given once every 3-4 days. Or 0.8 mg/kg body weight (maximum 50 mg), once a week. Stop treatment and see a doctor immediately if there is no change in condition after 6 months of using the drug.
- Ankylosing spondylitis and rheumatoid arthritisMature: 25 mg, 2 times a week, with administration every 3-4 days. Or 50 mg, once a week. Stop treatment and immediately discuss again with the doctor if there is no change in the condition after 6 months for the patient rheumatoid arthritis, or after 3 months in patients ankylosing spondylitis.
Golimumab
Medicine brand: Simponi
Drug form: intravenous injection
- Rheumatoid arthritisMature: The initial dose is 2 mg/kg by infusion over 30 minutes. A second dose is given 4 weeks later, and thereafter every 8 weeks.
Drug form: subcutaneous injection
- Rheumatoid arthritisMature: 50 mg, once a month.
- Ankylosing spondylitis
Mature: 50 mg, once a month.
- Arthritis in children
Children weighing 40 kg or more: 50 mg, once a month. Therapy can be evaluated whether the patient's response to treatment is good or not. If it's been 3-4 months the condition has not changed, discuss it again with your doctor.
- Ulcerative Colitis
Mature: The initial dose is 200 mg, followed by 100 mg after 2 weeks. Then 50 mg (if you weigh under 80 kg) or 100 mg (if you weigh 80 kg and over) every 4 weeks. Discuss again with the doctor if there is no change after the 4th dose.
Infliximab
Trademark: Remicade
Drug form: intravenous injection
- Crohn's disease
Mature: Initial dose 5 mg/kg, infusion over approx. 2 hours. The dose is repeated 2 weeks after the first infusion.
Children aged 6-17 years: Initial dose 5 mg/kg, infusion over approx. 2 hours. The dose was repeated 2 weeks and 6 weeks after the initial infusion, then the last dose was repeated every 8 weeks.
- Rheumatoid arthritisMature: Combination with methotrexate, the dose given is 3 mg/kgBW, infusion over approximately 2 hours. The dose is repeated 2 weeks and 6 weeks after the first infusion. The dose can be increased by 1.5-7.5 mg/kgBW if the patient's response to the drug is still considered inadequate.
- Ankylosing spondylitisMature: The initial dose is 5 mg/kg body weight. The dose is repeated at 2 weeks and 6 weeks after the initial dose, then adjusted every 6-8 weeks. Discuss again with the doctor if there is no change in condition after using 2 times the dose.
- psoriasis
Mature: The initial dose is 5 mg/kg, repeated 2 and 6 weeks after the first injection, then every 6-8 weeks. Discuss again with the doctor if the condition does not change after the 2nd dose.
- Ulcerative Colitis
Mature: The initial dose is 5 mg/kg, over approximately 2 hours. The dose is repeated 2 weeks and 6 weeks after the initial infusion, then every 8 weeks. Discuss with your doctor again if the condition does not change after the 3rd dose.
Children aged 6-17 years: The initial dose is 5 mg/kg, infusion over approx. 2 hours. Repeat at 2 weeks and 6 weeks after the first infusion, then every 8 weeks.
Secukinumab
Trademark: Fraizeron
Drug form: subcutaneous injection
- psoriasis
Mature: 300 mg, once weekly, for 5 weeks. Then the dose is given to once a month. Discuss again with the doctor if there is no improvement in the condition during 16 weeks of using the drug.
- Ankylosing spondylitis
Mature: 150 mg, once weekly, for 5 weeks. Then the dose is given once a month. Discuss again with the doctor if there is no improvement in the condition after 16 weeks of treatment.
Tocilizumab
Trademark: Actemra
Drug form: intravenous injection
- Rheumatoid ArthritisMature: The initial dose given is 4 mg/kgBW, once every 4 weeks. The dose can be increased to 8 mg/kg, once every 4 weeks via infusion, for 1 hour. The maximum dose is 800 mg per administration.
Drug form: subcutaneous injection
- Rheumatoid ArthritisMature: The initial dose given is 160 mg, once a week.
Ustekinumab
Trademark: Stellara
Condition: Crohn's Disease
- Intravenous injection
Adults weighing <55 kg: 260 mg given by infusion over approx. 1 hour.
Adults weighing 56-85 kg: 390 mg.
Adults weighing 86 kg or more: 520 mg. Maintenance dose:
Mature: 90 mg by subcutaneous injection, every 8-12 weeks, starting 8 weeks after the initial dose.
Condition: psoriasis
- Subcutaneous injection
Adult dbody weight < 100 kg: 45 mg.
mature bbody weight > 100 kg: 90 mg. Dosage was continued in the same amount 4 weeks later, and every 12 weeks. Discuss again with the doctor if there is no improvement in the condition after 28 weeks of treatment.
child uaged 12 years and over with <60 kg: 0.75 mg/kgBW.
Uaged 12 years and over with body weight 60-100 kg: 45 mg.
Uaged 12 years and over with body weight > 100 kg: 90 mg. The same dose is given 4 weeks later, and once every 12 weeks.
budesonide
Budesonide trademarks: Budenofalk, Budesonide, Obucort, Swinghaler, Pulmicort Respules, Pulmicort Turbuhaler, Rhinocort Aqua, Sonide
Condition: asthma
- inhaler
Mature: 200-800 mcg per day, divided into 1-2 usage schedules. The maximum dose is 800 mcg per day.
Children aged 5-12 years: 200-800 mcg per day, divided into 2 usage schedules.
- Nebulizer liquid
Mature and children >12 years: 1-2 mg, 2 times a day. The dose for maintenance is 0.5-1 mg, 2 times a day.
Infants from three months to 12 years of age: 0.5-1 mg, 2 times a day. The dose for maintenance is 0.25-0.5 mg, 2 times a day.
Condition: Croup
- Nebulizer liquid
Children: 2 mg as a single dose, or 1 mg twice 30 minutes apart. Administration of the drug can be repeated every 12 hours or every 36 hours if needed, until the condition subsides.
Condition: Allergic rhinitis
- nasal spray
Adults and children >6 years old: In preparations of 64-100 mcg, 1-2 sprays into each nostril, 2 times a day.
Condition: Nasal polyps
- nasal spray
Adults and children >6 years old: In preparations 64-100 mcg, 1 spray into each nostril, 2 times a day. Drug administration can be done for 3 months.
Condition: Crohn's Disease
- Capsule
Mature: 9 mg, once a day, taken before breakfast. Can also be divided into 3 consumption schedules, which are taken 30 minutes before eating. The drug can be taken for 8 weeks.
Prednisone
Prednisone trademarks: Eltazone, Etacortin, Ifison, Inflason, Lexacort, Pehacort, Prednisone, Remacort, Trifacort
Drug form: tablet
- Rheumatoid arthritis
Mature: The maximum dose is 10 mg per day.
- Asthma
Mature: 40-60 mg daily, once daily or in 2 divided doses, approximately for 3-10 days.
Children aged 0-11 years: 1-2 mg/kg per day, approx. 3-10 days. The maximum dose is 60 mg per day.
Everolimus
Trademark: Certican
Drug form: tablet
- Kidney cancer
Mature: 10 mg, 1 time a day. To prevent side effects, the dose will be reduced to 5 mg, 1 time a day.
- Organ transplant
Mature: 0.75 mg, twice daily, given immediately after transplantation.
Ciclosporin
Ciclosporin trademarks: Cipol – N, Imusporin, Sandimmun, Neoral
Drug form: tablet
- Rheumatoid arthritisMature: 2.5 mg/kg body weight per day, divided into 2 doses. Treatment should be carried out for up to 6-8 weeks. If the patient's response to the drug is not good enough, then the dose can be increased gradually, which is a maximum of 4 mg/kgBW per day.
- Organ transplant
Mature: The initial dose is 10-15 mg/kgBW per day, given 4-12 hours before transplantation, and continued for another 1-2 weeks.
- Psoriasis and severe atopic eczema
Mature: The initial dose is 2.5 mg/kg body weight per day, divided into 2 doses. Discuss again with your doctor if your condition does not improve, even though you have reached a maximum dose of 5 mg/kg body weight per day within 6 weeks.
Drug form: injection
- Organ transplant
Mature: The initial dose is 5-6 mg/kg per day, as a single dose. The infusion is carried out for 2-6 hours, then followed by tablet treatment.
Tacrolimus
Trademarks: Prograf, Protopic
Drug form: capsule
- Management of kidney transplant complications (body rejection of the transplanted organ)
Mature: The initial dose is 200-300 micrograms/kg body weight per day, divided into 2 doses. Or once daily for a slow-release capsule, given within 24 hours of transplantation.
- Management of pancreatic transplant rejection
Mature: The initial dose is 200 micrograms/kg body weight per day, divided into 2 doses. Or once a day (slow-release capsules).
- Management of lung transplant rejection
Mature: The initial dose is 100-150 micrograms/kg body weight per day, divided into 2 doses. Or as much as 1 time (slow-release capsules).
- Treatment of liver transplant rejection
Mature: The initial dose is 100-200 micrograms/kg body weight per day, divided into 2 doses. Or as much as 1 time (slow-release capsules).
Children: 300 micrograms/kg body weight, divided into 2 doses.
- Management of heart transplant rejection
Mature: The initial dose is 150 micrograms/kg body weight per day, divided into 2 doses. Or as much as 1 time (slow-release capsules).
Children: 200-300 micrograms/kg body weight per day, divided into 2 doses.
- Management of bowel transplant rejection
Mature: 300 micrograms/kg body weight per day, divided into 2 doses. Or once a day (slow-release capsules).
Drug form: ointment
- atopic eczema
Mature: In the ointment with a content of 0.03% or 0.1%, take an appropriate amount with the tip of the index finger, then spread evenly on the inflamed skin, 2 times a day. Discuss again with the doctor if the condition does not improve after using the drug for 2 weeks.
2 year olds to the top: In the ointment containing 0.03%, take an appropriate amount with the tip of the index finger, then apply it evenly on the infected skin, 2 times a day, for 3 weeks.
Azathioprine
Azathioprine trademark: Imuran
Drug form: film-coated tablet
- Rheumatoid arthritisAdults and children: The initial dose is 1 mg/kg per day, as a single dose or divided into 2 doses, for 6-8 weeks. The dose can be increased to 1.5 mg/kg body weight per day after 4 weeks if the patient's response to the drug is considered good. Or increased to 2.5 mg/kg body weight per day.
- Autoimmune disease
Adults and children: 1-3 mg/kg body weight per day. Discuss again with your doctor if the condition does not improve after 3-6 months of using the drug.
- Management of organ transplant rejection
Adults and children: 1.5 mg/kg body weight per day.
- Kidney transplant
Adults and children: 3-5 mg/kg body weight per day as a single dose, which is given when the first transplant will be performed. The dose can be re-administered 1-3 days after transplantation.
Leflunomide
Trademark: Arava
Drug form: film-coated tablet
- Rheumatoid arthritis and psoriatic arthritis
Mature: Initial dose 100 mg, once daily, for 3 days. The maintenance dose is 10-20 mg, 1 time a day.
Mycophenolate
Trademarks: Cellcept, Myfortic
Drug form: film-coated tablet
- Treatment of heart transplant rejection
Mature: The dose for mycophenolate mofetil content is 1.5 grams, 2 times a day, which is given 5 days after transplantation.
- Treatment of kidney transplant rejection
Mature: The dose for mycophenolate mofetil is 1 gram, given within 72 hours of transplantation. The maximum dose is 2 grams per day. For mycophenolic acid dosage is 720 mg, 2 times a day.
Children aged 2-18 years: The dose of mycophenolate mofetil is 600 mg/m² twice a day. Maximum 1 gram, 2 times a day.
Children aged 5-16 years: 400 mg/m² twice a day.
Elderly (>65 years): The maximum dose of mycophenolic acid is 720 mg, 2 times a day.