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HelpTest ID CYCPK Cyclosporine, Peak, Blood
Necessary Information
Date of last dose, time of last dose, and dosage information are required.
Specimen Required
Container/Tube: Lavender top (EDTA)
Specimen Volume: 3 mL
Collection Instructions:
1. Do not centrifuge.
2. Send whole blood specimen in original tube. Do not aliquot.
Additional Information: No definitive therapeutic or toxic ranges have been established for this peak testing.
Forms
If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:
-Renal Diagnostics Test Request (T830)
-Therapeutics Test Request (T831)
Secondary ID
42427Useful For
Monitoring whole blood peak cyclosporine concentration during therapy, particularly in individuals coadministered cytochrome P450 (CYP) 3A4 substrates, inhibitors, or inducers
Adjusting dose to optimize immunosuppression while minimizing toxicity
Evaluating patient compliance
Method Name
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
Cyclosporine, Peak, BSpecimen Type
Whole Blood EDTASpecimen Minimum Volume
1 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Whole Blood EDTA | Refrigerated (preferred) | 14 days |
| Ambient | 14 days | |
| Frozen | 14 days |
Clinical Information
Cyclosporine is a lipophilic polypeptide used to prevent rejection after solid organ transplantation; it suppresses T-cell activation by inhibiting calcineurin to decrease interleukin-2 (IL-2) production. There is substantial interpatient variability in absorption, half-life, and other pharmacokinetic parameters. Cyclosporine is extensively metabolized by cytochrome P450 (CYP) 3A4 to at least 30 less-active metabolites, many of which are detected by immunoassays. Cyclosporine is known for many drug interactions, including increased neuro- and nephrotoxicity when coadministered with antibiotics, antifungals, or other immunosuppressants. Cyclosporine has a narrow therapeutic range with frequent adverse effects making therapeutic drug monitoring essential. With 80% of cyclosporine sequestered in erythrocytes, whole blood is the preferred specimen for analysis.
Reference Values
No definitive therapeutic or toxic ranges have been established.
Optimal blood drug levels are influenced by type of transplant, patient response, time posttransplant, coadministration of other drugs, and drug formulation.
The following 2-hour postdose cyclosporine ranges are only suggested guidelines:
Kidney transplant: 800-1700 ng/mL
Liver transplant: 600-1000 ng/mL
Target steady-state peak concentrations vary depending on the type of transplant, concomitant immunosuppression, clinical/institutional protocols, and time posttransplant. Results should be interpreted in conjunction with this clinical information and any physical signs/symptoms of rejection/toxicity.
Cautions
Established (trough) cyclosporine reference ranges do not apply to specimens collected after administration of a dose. For trough specimens, order CYCSP / Cyclosporine, Blood.
Day(s) Performed
Monday through Sunday
Report Available
2 to 4 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
80158