Intravenously administered glucocorticoids , such as prednisone , are the standard of care in acute GvHD  and chronic GVHD.  The use of these glucocorticoids is designed to suppress the T-cell-mediated immune onslaught on the host tissues; however, in high doses, this immune-suppression raises the risk of infections and cancer relapse. Therefore, it is desirable to taper off the post-transplant high-level steroid doses to lower levels, at which point the appearance of mild GVHD may be welcome, especially in HLA mis-matched patients, as it is typically associated with a graft-versus-tumor effect. [ citation needed ] . Cyclosporine and tacrolimus are inhibitors of calcineurin. Both substances are structurally different but have the same mechanism of action. Cyclosporin binds to the cytosolic protein Peptidyl-prolyl cis-trans isomerase A (known as cyclophilin), while tacrolimus binds to the cytosolic protein Peptidyl-prolyl cis-trans isomerase FKBP12. These complexes inhibit calcineurin, block dephosphorylation of the transcription factor NFAT of activated T-cells and its translocation into the nucleus  . Standard prophylaxis involves the use of cyclosporine for six months with methotrexate. Cyclosporin levels should be maintained above 200 ng/ml  . Other substances that have been studied for GvHD prophylaxis include, for example: sirolism, pentostatin and alemtuzamab  .
Nolvadex is widely available and one of the easiest items on earth to obtain. In the . it is not classified as controlled substance; however, true legal possession will require a prescription. On the black market, nearly all anabolic steroid suppliers carry the SERM and counterfeits, while possible appear to be very rare. The SERM as with many related items is also available through research chemical labs (RCL’s). These RCL’s have found a loophole in the law that allows them to legally manufacture and sell SERM’s, AI’s, Peptides and many other items so as long as it’s for research only. This allows anyone to make a related purchase without a prescription and legally so. However, many of these RCL’s are very low grade. It’s common for their products to lose potency fast, to be unstable, and in some cases, so heavily concentrated they’re hard to dose. While there is a lot of garbage out there, there are quite a few very good RCL’s on the market. A little digging and you’ll easily find one.
Some of the generic drops have become expensive because of consolidation. For example, generic pred forte drops used to be very inexpensive but now there are only two companies that make it and those two companies are owned by the same two large pharmaceuticals that own the branded medicines, hence the price of the generic is almost the same as the expensive branded options. The price of drugs does vary from one pharmacy to another and each insurance plan has its preferred drugs which cost much less for patients depending on the deals they have made with the manufactures. For example brand A might be priced well at one store because they have made a good deal with the manufacturer and made it their preferred drug while brand B would be expensive. Across town a different drug store chain might have a great price for B and a high price for A because they have make B their preferred drug and have a great volume price with the manufacturer.
Alas, it is hard to find a cost effective way to protect your eyes around cataract surgery.