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. 2025 Jul 1;28(4):505-511.
doi: 10.4103/aian.aian_614_24. Epub 2025 Jan 31.

Neurotoxicity of Calcineurin Inhibitors

Aleksander Bajon  1 , Jędrzej Sikora  1 , Michal Siwek  1 , Julia Wiecanowska  1 , Miłosz Miedziaszczyk  2   3 , Ilona Idasiak-Piechocka  2 , Anna Mania  4
Affiliations

Neurotoxicity of Calcineurin Inhibitors

Aleksander Bajon et al. Ann Indian Acad Neurol. .

Abstract

Cyclosporine and tacrolimus belong to the immunosuppressive drugs of the calcineurin inhibitors group. They are widely used in the treatment of patients after organ transplants. One of their complications is neurotoxicity, the mechanism of which is still not fully understood. The main risk factor for neurotoxicity is hypertension. The most common symptoms include muscle tremors, which are more common in the upper limbs, as well as migraine headaches and peripheral neuropathies. The diagnosis of neurotoxicity is based on imaging tests (magnetic resonance imaging being the most commonly used) and assessment of clinical symptoms. Preventive measures should be initiated as soon as possible to prevent permanent damage to the nerve tissue. The possible preventive methods include reduction of the dose of the administered drug, temporary or complete discontinuation of drugs, or conversion to another immunosuppressive drug. It is also essential to monitor the patient's condition, correct hypertension, electrolyte disturbances, and fight possible infections. So far, effective methods of preventing calcineurin inhibitor-induced neurotoxicity have not been demonstrated.

Keywords: Calcineurin inhibitors; cyclosporine; neurotoxicity; tacrolimus; transplantation.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Mechanism of action of calcineurin inhibitors: CsA and tacrolimus[8] CsA: cyclosporine A, MHC: major histocompatibility complex, NFAT: nuclear factor of activated T cells, P: phosphorus, PLC: phospholipase C, TCR: T-cell receptor
See this image and copyright information in PMC

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