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SLE — SCE Rheumatology MCQ

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HardSLE & Antiphospholipid SyndromeSLESCE Rheumatology

A patient taking voclosporin 23.7 mg twice daily for lupus nephritis is prescribed diltiazem for rate control. Renal function is stable. Which voclosporin schedule is specified during this moderate CYP3A4 inhibition?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Use 15.8 mg in the morning and 7.9 mg in the evening

Explanation lettering: B = shown as A · C = shown as B · D = shown as C · A = shown as D

B is correct. Diltiazem is a moderate CYP3A4 inhibitor, so the UK SmPC reduces the total daily voclosporin dose to 15.8 mg in the morning and 7.9 mg in the evening. The asymmetrical schedule is deliberate. Stable eGFR does not remove the pharmacokinetic interaction, and the hepatic-impairment schedule of 15.8 mg twice daily should not be substituted for the interaction regimen.

Reference: Lupkynis 7.9 mg soft capsules SmPC: https://www.medicines.org.uk/emc/product/14381/smpc