Overview Snapshot A 40-year-old woman presents to the emergency department with worsening lower extremity weakness and decreased visual acuity of the right eye. She reports that her symptoms progressively worsened over the course of a week and after developing a urinary tract infection. Medical history is significant for multiple sclerosis treated with rituximab. Physical examination is significant for 1/5 strength in the lower extremities and an afferent pupillary defect appreciated in the right eye. Magnetic resonance imaging of the brain and spine shows new hyperintense lesions. She is started on intravenous methylprednisolone. Immunosuppressants Immunosuppressants Medication Clinical Use Mechanism of Action Adverse Effects Cyclosporine Rheumatoid arthritis Psoriasis Transplant rejection prophylaxis Calcineurin inhibitor impairs IL-2 production and release IL-2-induced T-cell activation Nephrotoxicity Neurotoxicity Hirsutism Gingival hyperplasia Hypertension Hyperlipidemia Tacrolimus (FK506) Transplant rejection prophylaxis Calcineurin inhibitor via binding with intracellular FKBP-12 protein which impairs IL-2 production and release IL-2-induced T-cell activation Nephrotoxicity Neurotoxicity ↑ risk of diabetes Sirolimus (Rapamycin) Lymphangioleiomyomatosis Renal transplantation prophylaxis mTOR inhibitor via binding with intracellular FKBP-12 protein which ↓ cytokine-induced T-cell proliferation Pancytopenia Hyperlipidemia Edema Insulin resistance Basiliximab Renal transplantation prophylaxis Targets the α-chain of the IL-2 receptor complex which is expressed on activated T-cells Edema Tremor Hypertension Azathioprine Rheumatoid arthritis Renal transplantation Inflammatory bowel disease A precursor of 6-mecaptopurine which incorporates itself into the cell's DNA and halts replication Pancytopenia Hepatotoxicity Mycophenolate mofetil Organ transplantation Lupus nephritis Inosine monophosphate dehydrogenase (IMPDH) inhibitor which impairs guanosine nucleotide synthesis Gastrointestinal upset Pancytopenia Hypertension Hyperglycemia Corticosteroids A number of autoimmune and inflammatory disorders NF-κB inhibitor Induces T-cell apoptosis Hyperglycemia Osteoporosis Cushing syndrome Adrenocortical atrophy Peptic ulcers Cataracts Avascular necrosis Psychosis