Voclosporin, sold under the brand name Lupkynis, is a calcineurin inhibitor used as an immunosuppressant medication for the treatment of lupus nephritis.It is an analog of ciclosporin that has enhanced action against calcineurin and greater metabolic stability.It was approved for medical use in the United States in January 2021, and in the European Union in September 2022. Medical uses
Lupus nephritis is a common form of glomerular nephritis occurring in patients with systemic lupus nephritis. Lupus nephritis commonly leads patients to chronic kidney failure and therefore places an emphasis on early intervention for improving treatment outcomes. Early intervention with voclosporin in combination with kidney response is believed to lead to more positive clinical outcomes for lupus nephritis patients. Thus, voclosporin is used in combination with background immunosuppressive regimen for the treatment of lupus nephritis. Safety has not been established in combination with cyclophosphamide. Contraindications
Patients who are breastfeeding or plan to breastfeed should not take this medication as it may cause fetal harm. Voclosporin is not recomnended in patients with a baseline eGFR less than or equal to 45 ml/min/1.73 m2 unless benefits exceeds risk. Dose should be reduced if the drug is used within this population as well as for patients who are hepatically impaired. Avoid the use of live attenuated vaccines when patients are on this medication. Avoid co-administration of voclosporin and other moderate to strong CYP3A4 inhibitors and if needed then reduce the dose of voclosporin. Dosages of PgP-substrate drugs should be reduced if co-administered with voclosporin.
Jugular foramen syndrome, or Vernets syndrome, is characterized by paresis of the glossopharyngeal, vagal, and accessory (with or without the hypoglossal) nerves. Symptoms
Symptoms of this syndrome are consequences of this paresis. As such, an affected patient may show:
dysphonia/hoarseness
soft palate dropping
deviation of the uvula towards the normal side
dysphagia
loss of sensory function from the posterior 1/3 of the tongue (CN IX)
decrease in the parotid gland secretion (CN IX)
loss of gag reflex
sternocleidomastoid and trapezius muscles paresis (CN XI)

Causes
Glomus tumors (most frequently)
Meningiomas
Schwannomas (Acoustic neuroma)
Metastatic tumors located at the cerebellopontine angle
Trauma
Fracture of occipital bone
Infections
Cholesteatoma (very rare)
Obstruction of the jugular foramen due to bone diseases
Nasopharyngeal carcinoma spreading into the parapharyngeal space involving the ninth, tenth, and eleventh cranial nerves

Diagnosis
Gadolinium enhanced mri for vestibular schwannoma
mri and biopsy for nasopharyngeal carcinoma
based on nerve palsies
NCCT for occipital bone fracture


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