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What is cyclosporine?

Cyclosporine (sai·kluh·spaw·ruhn) is a medication used mainly to prevent transplanted organs or tissue from immune system rejection.

Following a transplant, the immune system will detect something foreign, which sets off a response to attack and destroy the new organ or tissue. Medication like cyclosporine inhibits this response so that transplantation can succeed.

Doctors also prescribe cyclosporine to help with treatment-resistant autoimmune conditions. Cyclosporine’s drug classification is an immunosuppressant.  Cyclosporine is the generic drug name. Sandimmune and Neoral are two common cyclosporine brands. 

What is cyclosporine used to treat?

Organ transplant rejection

Doctors prescribe cyclosporine mainly to recipients of organ transplants, such as heart, kidney, or liver transplants. 

Cyclosporine works by preventing the new organ from being attacked and rejected by the body’s immune system as though it is something harmful (like an infection or tumor).

Autoimmune conditions

Cyclosporine is also used to treat a wide variety of autoimmune conditions, including:

How do you take cyclosporine?

Cyclosporine can be taken intravenously or orally and the oral form is available as either a capsule or liquid solution. The dosage will depend on your health profile and the condition cyclosporine is treating. 

The following information is a guideline only. Take cyclosporine exactly as directed by your doctor. Do not exceed the recommended dosage or take cyclosporine more frequently unless your doctor tells you to.

Taking cyclosporine to prevent organ transplant rejection

Cyclosporine dosage will be determined by your doctor, depending on the type of organ transplant received, time post-transplant and the patient’s other medications and medical conditions.

Taking cyclosporine to treat psoriasis or rheumatoid arthritis

Adults

Your dosage will be determined by your doctor. A starting dose is usually 2.5mg per kg of body weight, twice a day, adjusted by your doctor as necessary.

Children

Suitability and appropriate dosage can only be determined by a doctor.

Seeing results

Relief from psoriasis symptoms

In clinical trials, 80% to 90% of patients who received cyclosporine for 12–16 weeks had rapid improvement.¹

Relief from rheumatoid arthritis symptoms

Several clinical trials have shown cyclosporine, especially as a combination therapy,  to be effective in the management of the aggressive rheumatoid disease.

Transplantation

Cyclosporine may be prescribed long-term to transplant recipients. Results of cyclosporine vary from person to person.

Potential side effects of cyclosporine

Common side effects

High blood pressure and kidney problems are common side effects of cyclosporine and are more likely to occur in elderly people.² Often kidney toxicity is reversible, on stopping cyclosporine. Other common side effects of cyclosporine may include: Gum irritation or inflammation

If you experience swollen gums while taking cyclosporine, speak to your doctor. This side effect is usually associated with taking higher doses of cyclosporine and will typically resolve when the dosage is lowered. Only reduce cyclosporine if and when your doctor tells you to do so. Numbness or tingling in the hands or feet

If you experience changes to sensation in your hands or feet while taking cyclosporine, speak to your doctor. The symptom may indicate that your cyclosporine dosage is too high. Only reduce cyclosporine if and when your doctor tells you to do so.

Additional side effects of cyclosporine may include: 

Immune system performance is decreased by cyclosporine, which can raise the risk of infections. Cyclosporine has the potential to damage the liver and kidneys in high doses. 

It can also raise the risk of some types of cancer, including lymphoma and skin cancer

Long-term use of cyclosporine

In general, one can remain on cyclosporine indefinitely, as long as there is evidence that the drug is providing some benefit and there are no significant adverse side effects. The duration of treatment will depend on the condition it is being used to treat. Clinical guidelines suggest waiting at least four weeks after cyclosporine treatment before resuming. Long-term usage and a high dosage are associated with cyclosporine toxicity.⁴

In transplant patients

Extended use of cyclosporine may be appropriate for some organ transplant patients.

For psoriasis and other autoimmune conditions

Long-term therapeutic use of cyclosporine is uncommon. It is considered unsuitable as a single long-term therapy for psoriasis.⁴

Missed doses

If you miss a dose of cyclosporine, take it as soon as you remember. However, if you are too close to the timing of the next dose, skip it and take the next dose as planned. In general, doses should be at least 12 hours apart. Try to take your medication on a regular schedule and avoid missed doses. Do not take two doses of cyclosporine at the same time.

Overdoses

If someone has taken too much cyclosporine or taken it accidentally, call 911 or go to the nearest emergency room. Cyclosporine taken incorrectly can be fatal. 

Possible signs of cyclosporine toxicity (poisoning) or overdose include:

  • Fatigue

  • Vomiting

  • Fast heart rate 

  • Yellowing of the skin (jaundice)

  • Kidney damage

What to discuss with your doctor before taking cyclosporine

Here are some of the things you must discuss with your doctor before taking cyclosporine: 

  • All the medications you’re currently taking (prescribed or non-prescribed). 

  • All the vitamins and supplements you are taking or planning to take.

  • Allergies to specific medications (especially cyclosporine). 

  • Liver or kidney problems or a history of such.

  • Whether or not you consume alcohol, how much, and how frequently. Alcohol may increase the possibility of liver damage. In addition, taking cyclosporine with ezetimibe, a cholesterol-lowering medication, can also lead to liver damage. 

  • Whether you are pregnant or trying to get pregnant.

  • Whether you are currently breastfeeding or planning to breastfeed.

Stopping cyclosporine

If your doctor prescribes cyclosporine, following your doctor's instructions is essential. Talk to your doctor before stopping or changing your dosage for any reason. You may become seriously ill if you stop taking this medicine suddenly.

Cyclosporine and pregnancy

Cyclosporine falls into the US Food and Drug Administration (FDA) Category C, meaning that risk to the fetus is possible. 

If you become pregnant while taking this medication, inform your doctor. Discuss the possible risks and benefits and whether or not you should continue this medication. Those who receive cyclosporine therapy during pregnancy have reportedly higher rates of preterm delivery, maternal hypertension (high blood pressure), low birth weight, and intrauterine growth restriction (IUGR), in which the fetus does not grow as expected.⁵

During pregnancy, this drug should only be taken when absolutely necessary. Discuss the potential risks and benefits with your doctor.

Cyclosporine and interactions with other drugs

Cyclosporine can interact with other drugs. If your doctor requires you to be on the following medication, in addition to cyclosporine, adjustment of the other medications may be required. The most common interactions are with:

  • Nephrotoxic substances Certain drugs are potentially poisonous to the kidneys when combined with cyclosporine. These may include, but are not necessarily limited to: 

    • Aminoglycosides (a class of antibiotics including streptomycin, neomycin, as well as others)

    • Angiotensin-converting enzyme (ACE) inhibitors for high blood pressure

    • Non-steroidal anti-inflammatory drugs (NSAIDs) for pain or fever management such as ibuprofen (Advil, Motrin), acetaminophen (Tylenol), or aspirin (Aspirin, Bayer)

  • Other immunosuppressants Tacrolimus (Prograf) and other immunosuppressive drugs should not be taken at the same time as cyclosporine, unless specified by your doctor.

  • Calcium channel blockers Cyclosporine interacts with medications that lower blood pressure such as diltiazem (Cardizem) and amlodipine (Norvasc).

  • Corticosteroids Anti-inflammatory drugs like prednisone and cortisone.

  • Antacids

  • Alcohol

  • St. John’s Wort

The above list is not complete. Tell your doctor about all the drugs you take, including over-the-counter drugs, vitamins, and herbal supplements, especially products that contain potassium. 

In addition, cyclosporine can interact with some foods and drinks, so it's important to talk to your doctor about what you can and cannot eat or drink while taking this medication. 

Avoid eating grapefruit or drinking grapefruit juice while taking cyclosporine, as it can increase the levels of cyclosporine in the blood.⁶

Allergy information

Severe allergic reactions to cyclosporine are rare. Call 911 or visit the nearest emergency room if you experience:

  • Hives

  • Rashes

  • Difficulty breathing

  • Swelling of the face, throat, and lips

Clinical trial history

Sandimmune

  • 1983 The US Food and Drug Administration (US FDA) first approved the cyclosporine brand Sandimmune to treat organ rejection in kidney, liver, and heart transplants.

Neoral

  • 1995 The US Food and Drug Administration's Immunosuppressant Drug Subcommittee to the Antiviral Drugs Advisory Committee approved the cyclosporine brand, Neoral, for preventing organ rejection in kidney, liver, and heart transplants recipients.⁷

  • 1997 The US Food and Drug Administration (US FDA) approved Neoral, for treating severe cases of psoriasis in adults who are not immune-compromised.⁸

  • 1999 The US Food and Drug Administration (US FDA) approved Neoral for treating rheumatoid arthritis when the disease has not adequately responded to methotrexate.⁹

Tips and advice for taking cyclosporine

Cyclosporine is used to help treat autoimmune diseases, such as rheumatoid arthritis, psoriasis, and lupus. 

It is a powerful drug that can have serious side effects if taken incorrectly. 

Here are some tips and advice for taking cyclosporine:

  • Always take cyclosporine exactly as prescribed by your doctor.

  • Do not skip doses or stop taking cyclosporine without first talking to your doctor.

  • Cyclosporine can make you more susceptible to infections, so be sure to wash your hands often and avoid close contact with people who are sick.

  • Protect your skin from sun damage while taking cyclosporine by using sunscreen and seeking shade when outside.

  • You will need to have your blood pressure and kidney function checked regularly while taking cyclosporine.

  • Some of the common side effects of cyclosporine include headache, nausea, vomiting, dizziness, and increased hair growth.

If you have any questions or concerns about taking cyclosporine, talk to your doctor.

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Disclaimer

Here at HealthMatch, we’ve done our best to ensure that the information provided in this article is helpful, up to date, and, most importantly, accurate.

However, we can’t replace the one-to-one advice of a qualified medical practitioner or outline all of the possible risks associated with this particular drug and your circumstances.

It is therefore important for you to note that the information contained in this article does not constitute professional medical or healthcare advice, diagnosis or recommendation of treatment and is not intended to, nor should be used to, replace professional medical advice. This article may not always be up to date and is not exhaustive of all of the risks and considerations relevant to this particular drug. In no circumstances should this article be relied upon without independent consideration and confirmation by a qualified medical practitioner.

Your doctor will be able to explain all possible uses, dosages, precautions, interactions with other drugs, and other potential adverse effects, and you should always talk to them about any kind of medication you are taking, thinking about taking or wanting to stop taking.

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