Medications

Table 15.5 is a list of common transplant medications that have neuropsychiat-ric effects. It often can be difficult to know the offending agent because drugs frequently are prescribed concurrently. Cyclosporine is a lipophilic polypeptide that is derived from a fungus, Tolypocladium, and has been a mainstay of immunosuppression since 1978. The microemulsion form, Neoral, allows for greater bioavailability of cyclosporine. Neuropsychiatric side effects include anxiety, headache tremor, white matter changes, central pontine myolisis, cortical bleeding, ataxia, seizures, disorientation and visual hallucinations. Corticosteriods, such as Prednisone, are associated with anxiety; depression, delirium and mania are generally a dose-related manner. Prednisone doses above 40 mg are associated with

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