DR Medhat MRCP

E. Other cytotoxic drugs
Cytotoxic Mechanism of action Adverse effects
Cisplatin
Hydroxyurea
(hydroxycarbamide)
Mycophenolate mofetil
(MMF)
(Cellcept, myfortic)
- Causes Cross-linking in DNA
- Inhibits ribonucleotide
reductase, decreasing DNA
synthesis
- Inhibit inosine monophosphate
dehydrogenase (IMPDH) - -
Purine synthesis (hence DNA)
- - proliferation of B & T cells.
1) Ototoxicity
2) Peripheral neuropathy
3) Hypomagnesaemia
Myelosuppression
1) GIT upset ( diarrhea &
abdominal pain)
2) Myelosuppresion
3) Hyper-glycemia
4) Hyper-kalemia
5) Hyper-cholesterolemia
6) Hypo-magnesemia
7) Hypo-calcemia
Calcineurin inhibitors :
Ciclosporin
(Neoral ,Sandimmune)
Tacrolimus
(Prograf)
Mechanism of action
Clonal proliferation of T-
cells by - - IL2 release by
binding to cyclophillin
forming a complex which - -
calcineurin (protein
phosphatase that ++ growth
of T-cells)
Macrolid antibiotic , has the
same action as ciclosporin
but it bind to protein called
FKBP instead of cyclophillin
Common side effects
1. Nephrotoxicity.
2. Hepatotoxicity.
3. Fluid retention.
4. Hypertension.
5. Hyperkalaemia.
6. Hypertrichosis.
7. Hyperplesia of the gum.
8. Tremors .
9. Impaired glucose tolerance
1. Nephrotoxicity.
2. Hepatotoxicity.
3. Hyperkalaemia.
4. Hyperglycaemia.
5. Hypomagnesaemia
6. Cardiomyopathy.
7. Neuropathy.
8. Encephalopathy, Depression.
9. Cramps, Seizures .
o Unlike the similarly named tacrolimus, sirolimus (rapamycin) is not a calcineurin
inhibitor, but it has a similar suppressive effect on the immune system.
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