Cyclosporine syringe: A pragmatic approach for accurate cali
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Cyclosporine is well tolerated by the pediatric population as compared to the adult population. Children shows excellent responses with a very low incidence of adverse effects. The American academy of dermatology, recommends monitoring whole-blood cyclosporine trough levels in children only if there is an inadequate clinical response or concomitant use of potentially interacting drugs.

A wide range of nanoparticles have been explored for the delivery of highly hydrophobic drugs. The microemulsified form of CsA has been shown to be safe and effective in the pediatric population.

There is a practical difficulty in giving CsA to an infant, particularly an underweight infant. The dose quantification from the routinely available oral solution can be quite problematic in small babies who fail conventional therapy and require CsA as a treatment option. The oral solution is commercially available as 100 mg per ml of CsA. There is hardly any other pediatric drug in solution which is dispensed in so much of a concentrated formulation. Hence utmost care needs to be taken to calculate the proper dose of CsA because just an error of 1 ml means a difference of 100 mg.

The use of an insulin syringe for dose titration is advised . In an insulin syringe, 1 ml is divided into 40 equal units. Each unit is, therefore of 0.025 ml. Thus, each unit represents 2.5 mg of CsA. The use of insulin syringe for dose calculation helps to achieve accurate calibration to as low as 2.5 mg of CsA oral solution, which is otherwise not possible routinely with cyclosporine.

The left-over preparation should be discarded. The easy operation of an insulin syringe in terms of drawing a very small amount for the underweight infant makes it pertinent and useful as far as accurate dosing is concerned. A clinical demonstration should be given to parents to facilitate home preparation and administration. The desired weight-dependent dose should be administered within 10 min of preparation of the final formulation to prevent any contamination.