Home Drug Guide Voclosporin

Drug Guide

Generic Name

Voclosporin

Brand Names Lupkynis

Classification

Therapeutic: Immunosuppressant for autoimmune diseases, especially lupus nephritis

Pharmacological: Calcineurin inhibitor

FDA Approved Indications

  • Treatment of active lupus nephritis in adult patients

Mechanism of Action

Voclosporin inhibits calcineurin, leading to decreased T-cell activation and cytokine production, thereby suppressing the immune response involved in lupus nephritis.

Dosage and Administration

Adult: Starting dose of 23.7 mg twice daily, adjusted based on response and tolerability.

Pediatric: Not FDA-approved for pediatric use.

Geriatric: Use with caution; no specific dosage adjustment recommended but monitor closely.

Renal Impairment: Adjust dose as necessary; renal function should be monitored.

Hepatic Impairment: No specific adjustment provided; monitor liver function.

Pharmacokinetics

Absorption: Rapidly absorbed with peak concentrations in approximately 1-2 hours.

Distribution: Bound extensively to plasma proteins.

Metabolism: Primarily metabolized by CYP3A4 enzyme.

Excretion: Excreted mainly in feces; minor renal excretion.

Half Life: Approximately 12 hours.

Contraindications

  • Allergy to voclosporin or other calcineurin inhibitors.
  • Use with potent CYP3A4 inhibitors without dose adjustments.

Precautions

  • Monitor blood pressure, renal function, and signs of infection; avoid live vaccines; use with caution in patients with hepatic impairment.

Adverse Reactions - Common

  • Nephrotoxicity (Common)
  • Hypertension (Common)
  • Headache (Common)
  • Diarrhea (Common)

Adverse Reactions - Serious

  • Serious infections (Less common)
  • Malignancies (e.g., lymphoma, skin cancer) (Less common)
  • Neurotoxicity (Uncommon)
  • Liver injury (Uncommon)

Drug-Drug Interactions

  • Potent CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) increase voclosporin levels.

Drug-Food Interactions

  • Grapefruit juice may increase levels by inhibiting CYP3A4.

Drug-Herb Interactions

  • St. John's Wort may decrease efficacy by inducing CYP3A4.

Nursing Implications

Assessment: Monitor renal function, liver function, blood pressure, and signs of infection.

Diagnoses:

  • Risk for infection related to immunosuppression.
  • Risk for renal impairment.

Implementation: Administer as prescribed; monitor labs regularly; counsel patient on infection prevention.

Evaluation: Assess response to therapy and adverse effects periodically.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report signs of infection, unusual bleeding, or side effects.
  • Avoid live vaccines during treatment.
  • Maintain regular follow-up appointments.

Special Considerations

Black Box Warnings:

  • Increased risk of infections and lymphoma due to immunosuppression.

Genetic Factors: Genetic variations in CYP3A4 may affect drug metabolism.

Lab Test Interference: May interfere with certain lab tests; inform laboratory personnel of medication use.

Overdose Management

Signs/Symptoms: Severe immunosuppression, bleeding, kidney or liver dysfunction, neurotoxicity.

Treatment: Supportive care, discontinuation of drug, and symptomatic management.

Storage and Handling

Storage: Store at room temperature away from moisture and heat.

Stability: Stable for up to the period specified in the package insert when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.