MICROEMULSION FORMULATION OF CYCLOSPORINE IN PEDIATRIC LIVER-TRANSPLANTATION

The oral bioavailability of Sandimmun can be impaired by cholestasis, external biliary diversion, and diarrhea. We report two cases of pedia tric liver transplant recipients who experienced chronic rejection and diarrhea secondary to proximal bowel resection. These conditions resu lted in poor oral absorption of Sandimmun; the children were converted to the new oral microemulsion formulation Neoral, which significantly improved oral absorption, allowing intravenous cyclosporine weaning a nd patient discharge. Comparative pharmacokinetic studies were perform ed in both cases, and the relative Neoral/Sandimmun bioavailabilities were 32.9 and 5.4, respectively. Accordingly, Neoral may constitute a good alternative to ensure the effectiveness of oral cyclosporine admi nistration, particularly in Liver-transplanted children with severe ch olestasis or shortened small bowel.