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whereas nonselective immunosuppressants, which comprise glucocorticoids, cyclophosphamide, antimetabolites such as methotrexate and leflunomide, as well as herbal extracts like tripterygium wilfordii and sabia japonica maxim, exhibit a broader spectrum of effects, impacting multiple aspects of the immune system (242, 243) Although immunosuppressants are effective in reducing the overreaction of the immune system to pathological environments such as hypoxia, the accompanying heightened risk of complications, such as the development of malignant tumors, infectious diseases, and osteoporosis, underscores the need for an ideal immunosuppressant agent that is not only highly selective and fast-acting but also efficacious, with the capability to reverse its effects upon drug discontinuation, and possesses minimal side effects without compromising normal immune function

In the USA, the maximum dosage per day recommended by the manufacturer (MacNeil Consumer Healthcare) was reduced from 4000 mg (eight 500 mg pills) to 3000 mg (six 500 mg pills) in 2011[35]