Immunosuppressant drugs suppress the immune system and are primarily used after organ transplantation to prevent transplant rejection. There are two main types of immunosuppressants: induction drugs used short-term after transplantation and long-term maintenance drugs. Common immunosuppressants include cyclosporine, tacrolimus, sirolimus, mycophenolate mofetil, azathioprine, corticosteroids, and monoclonal antibodies. These drugs work by inhibiting T-cell activation and cytokine production to decrease the immune response to foreign transplanted organs.

1. Miscellenious Drug

2. Immunosuppressant(anti-rejection drugs)
 These drugs are a class of drugs that suppress or reduce
the strength of the body's immune system.
 One of the primary uses of these drugs is to lower the
body's ability to reject a transplanted organ, such as a liver,
heart or kidney
 who receives an organ transplantation has almost to take
this drugs.
 The body recognizes a transplanted organ as a foreign
mass and this drugs decrease the body's reaction to the
foreign organ.
 The drugs allow the transplanted organ to remain healthy
and free from damage.
 This drugs also are used to treat autoimmune diseases
such as lupus.
In general there are two types of immunosuppressants:
 Induction drugs: Powerful antirejection medicine used at

3. Classification of Immunosuppresant
1. Selective inhibitors of cytokine production and
function:
 Cyclosporine, tacrolimus , and sirolimus.
2. Immunosuppressive antimetabolites:
 Azathioprine, mycophenolate mofetil mycophenolate
sodium
3. Antibodies:
 Muromonab-CD3, Alemtuzumab, basiliximab,
daclizumabel
4. Adrenocorticoids:
 Methylprednisolone, prednisone

4. Cyclosporine
 Also called cyclosporin, is a calcineurin inhibitor, used as
an immunosuppressant medication. It is a natural product
Mechanism of Action
 Inhibition of production and release of interleukin II and
inhibits interleukin II-induced activation of resting T-
lymphocytes.
Indication:
 prevent rejection of organ transplantation
 alternative to methotrexate for the treatment of severe,
active rheumatoid arthritis
 Psoriasis
 Crohn’s disease
 Ulcerative colitis

5. Side-effect:
 excess hair growth in certain areas - acne
 high blood pressure - fatigue
 tremors or shaking; - decreased
kidney function
 stomach pain - muscle, bone,
or joint pain
 increased gum size
Contraindication:
 uncontrolled hypertension,
 uncontrolled infections
 Renal dysfunction
Dose:
Organ transplant: 5-7 mg/kg/dose BDS starting 12 hours
before transplant and continued for 1-2 weeks

6. Mycophenolate Mofetil (MMF)
 is an antimetabolite immunosuppressant.
 prodrug of mycophenolic acid (MPA), an inhibitor of
inosine-5'-monophosphate dehydrogenase.
Mechanism
 It is an inhibitor of inosine -5’- monophosphate
dehydrogenase (IMPDH) which inhibits de novo pathway
of guanosine nucleotide synthesis. T and B lymphocytes
are dependent on this pathway for proliferation.
Indication
 It is used for the prevention of renal, liver and cardiac
transplantation rejection
 auto-immune disease (lupus nephritis).

7. Adverse effects:
 Vomiting Diarrhoea
 Anaemia Haematurea
 BP change
 Acne Alopecia
 Rashes
 Insomnia Dizziness, Headache
Contraindications
 Hypersensitivity
Dose:
 600 mg/m/dose 2 times daily First dose within 72 hours
after transplant Max 2 gm/day

8. Muromonab-CD3
 It is an immunosuppressant drug
 It is a monoclonal antibody targeted the CD3 receptor,
a membrane protein on the surface of T cells.
 It was the first monoclonal antibody to be approved for
clinical use in humans.
Mechanism of action:
 Muromonab binds to the T-cell surface glycoprotein CD3
epsilon chain. It appears to kill CD-3 positive cells by
inducing Fc mediated apoptosis, antibody mediated
cytotoxicity and complement-dependent cytotoxicity.
Indication:
 used as immunosuppressive therapy in kidney, heart, and
liver transplant patients.

9. Side-effect:
 dizziness or faintness
 fever and chills
 headache
 muscle or joint pain
 nausea and vomiting, Diarrhea
 general feeling of discomfort or illness
Contraindication:
 Sever bone marrow supression
 Hypersensativity
Dose:
100mg/m2 per cycle, once every 4 weeks IV

10. Application of Gene Therapy
 It is concept of the introduction of normal genes into cells
in place of missing or defective ones in order to correct
genetic disorders.
 It the genetic modification of cells to produce a therapeutic
effect or the treatment of disease by repairing or
reconstructing defective genetic material.
 1. CAR-Engineered Stem Cells that Treat HIV
 2. Engineered Natural Killer Cells against Hodgkin’s
Lymphoma
A. Somatic Gene Therapy
 This type usually occurs in the somatic cells of human
body.
 In this method, therapeutic genes are transferred into the
somatic cells or the stem cells of the human body.
B. Germline Gene Therapy
 It occurs in the germline cells of the human body.

11. Application
 It is used in the replacement of genes that cause medical
ill-health
 The method generally destroys the problem causing
genes
 It helps the body to fight against diseases by adding
genes to the human body
 This method is employed to treat diseases such as
cancer