Voclosporin (Lupkynis)
Voclosporin is a medication used to treat lupus that is affecting the kidneys (lupus nephritis) by suppressing the immune system.
Voclosporin works by reducing the activity of T-cells, a type of white blood cell that plays an important part in the body’s immune system.
Taking Voclosporin
Voclosporin is available in 7.9 mg oral capsules.
The normal dose of Voclosporin is 23.7 mg (three 7.9 mg capsules) taken twice per day. The dose may be lowered based on your kidney or liver function.
Doses should be spaced 12 hours apart. Do not take the medication less than 8 hours apart.
It can take some time for the Voclosporin to work. It is important for people starting this medication to be patient and to keep taking it as prescribed.
Important Tests and Risks
Patients taking Voclosporin should get their blood and urine tested regularly (every two weeks to every month).
It is important for doctors to make sure that Voclosporin is not affecting the blood counts, potassium levels, or the kidneys.
Patients starting Voclosporin should have their blood pressure checked every week for the first month of therapy, and then every month after that, for as long as they are taking the medicine.
Voclosporin can make it a bit harder for people to fight off infections.
People taking this medicine should call their doctor they have a fever, think they have an infection, or have been prescribed antibiotics to treat an infection.
It’s important for patients to coordinate with their doctors and stop treatment before any surgery. Treatment can be re-started once things have healed and there’s no sign of infection.
Patients should discuss all vaccinations with their doctor because some are not advisable to get while taking Voclosporin.
Several prescription medications can interact with Voclosporin. Some examples of medications known to interact with Voclosporin include clarithromycin, ketoconazole, or itraconazole.
Patients should make sure that their doctor knows every medicine and supplement that they are taking.
Common over-the-counter medications including cold remedies, pain medication, cough syrup, and laxatives are not known to interact with Voclosporin.
It is not known how Voclosporin could interact with most herbal medications.
Voclosporin should not be taken with grapefruit juice because it interferes with the absorption of the medication.
It is recommended that patients taking Voclosporin drink 8 to 10 glasses of water per day (1.5 liters) to help their kidney function.
Science
Voclosporin works by reducing the activity of T-cells, a type of white blood cell that plays an important part in the body’s immune system.
Voclosporin binds to a protein cyclophilin (immunophilin) found on the surface of white blood cells, especially T-cells. This triggers a chain of reactions that reduces the function of these cells.
In preventing T-cells from working normally, Voclosporin suppresses a part of the body’s immune system. Although this suppression may make it slightly harder for patients to fight off infections, it also helps to stabilize an overactive immune system.
Safety
Voclosporin can irritate the liver. Regular blood tests are important for doctors to monitor blood counts and make sure that the liver or kidneys are not being harmed. Patients should drink 8-10 glasses of water per day to flush the kidneys.
MINOR side-effects include:
- Nausea, bloating, abdominal cramps, and diarrhea.
- Heartburn
- Mouth ulcers
- Fatigue or weakness
- Muscle cramps and tremors
- Hair loss
- Headaches - Patients should tell their doctor if they experience this side effect
- Swelling of the ankles – Patients should tell their doctor if they experience this side effect
RARE side-effects include:
- Kidneys – Voclosporin may affect kidney function. Kidney function is monitored closely with blood tests while you are taking Voclosporin. When monitored closely, any change in kidney function is usually reversible by reducing the dose or stopping the Voclosporin.
- High Blood Pressure – Voclosporin may cause an increase in blood pressure. If this should happen, the dose of your Voclosporin may be adjusted or a medication to control your blood pressure may be prescribed.
- Infection – Any infections or fevers should be taken seriously and reviewed by your doctor.
- Heart – Voclosprin can rarely affect the heart rhythm. Let your doctor know if you have any heart problems. This can be made worse if combined with certain medications.
- Brain and Nerves - Voclosporin can rarely be harmful to the brain and nerves. Let your doctor know if you develop a headache, a change in your vision, tremors, tingling in the fingers, toes, tip of the nose, tongue, or lips, or any confusion.
- Malignancy – When used for long periods of time, Voclosporin may be associated with a small increased risk of lymphoma and skin cancers. These cancers may be reversible when the medication is stopped.
How to minimize the side-effects of Voclosporin:
- Regular monitoring is important. Patients should take Voclosporin as prescribed, get regular blood tests, have regular blood pressure checks, and attend all appointments with their doctor.
- Patients should drink 8 to 10 glasses of water per day (1.5 liters) to help kidney function.
- Patients should report any infections to their doctor.
Patients should talk to their doctor if they are concerned about any side effects when taking Voclosporin.
Voclosporin is not considered safe in pregnancy or breastfeeding. Anyone who is thinking of becoming pregnant or becomes pregnant while taking Voclosporin should let their doctor know.
People who should NOT take Voclosporin include:
- Patients who have had a previous serious reaction to Voclosporin
- Some patients with diseases of the liver or kidney
- Patients with uncontrolled high blood pressure
- Patients with active uncontrolled infections
- Possibly patients with a past history of cancer
- Patients with other diseases which affect the immune system (e.g. HIV)
People taking Voclosporin should call a doctor if they feel sick and want to stop, or if they are concerned about any side effects.
Other reasons to call a doctor while taking Voclosporin include:
- New high blood pressure
- Fever or possible infection
- Pregnant or planning pregnancy
- Severe new headache
- Upcoming surgery
Anyone who becomes pregnant while taking Voclosporin should notify their doctor immediately.
Pregnancy and medications