Psychotoxicity of Immunomodulators: Corticosteroids, Mycophenolate, Tacrolimus, Cyclophosphamide, and Hydroxychloroquine

Immunomodulating agents are commonly used in nephrology, both for inflammatory renal disease and post-renal transplant to suppress graft rejection. The psychiatric side effects of these agents are among the most problematic side effects observed. Acute presentations of these phenomena commonly generate consultation-liaison psychiatric consultations for acutely ill hospitalized patients. Accurate ascertainment of cases and precise psychiatric diagnosis are necessary for appropriate management. Treatment typically necessitates withdrawal, dose reductions, or switching of immunosuppressive regimens. Empiric off-label use of psychopharmacologic agents to target the manifest psychiatric symptoms may be needed with close monitoring. This topic illustrates the connection between nephrology and psychiatry in the co-management of these patients.