The tests to be conducted before initiating cyclosporine A include CBC, urine routine, serum creatinine, LFT, fasting lipids, and blood pressure. Possible drug interactions with cyclosporine also need to be considered (Chakravarty K et al. 2008). The presence of elevated creatinine and renal involvement are contraindications to use cyclosporine. The dose should be adjusted in patients with hepatic dysfunction. Baseline blood pressure monitoring is recommended to avoid hypertension, one of the common adverse effects of cyclosporine treatment. Similar pre-evaluation process is followed for tacrolimus. Moreover, clinical evaluation for the presence of infections, including tuberculosis and hepatitis B, is required before starting both the drugs. If suspected, appropriate work-up should be conducted to diagnose the infection. If the infection is confirmed, it should be treated before initiating the treatment.

REFERENCE

1. Chakravarty K, McDonald H, Pullar T, Taggart A, Chalmers R, Oliver S, Mooney J, Somerville M, Bosworth A and Kennedy T. BSR/BHPR guideline for disease- modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Association of Dermatologists. Rheumatology 2008; 1-16.