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Cyclosporine
Cyclosporine is a prescription medication used to prevent transplant rejection in those who have received kidney, liver, and heart transplants. Cyclosporine may also be used to treat psoriasis and symptoms of rheumatoid arthritis. Cyclosporine eye drops are prescribed to increase tear production in people with chronic dry eye disease caused by inflammation.
Cyclosporine belongs to a group of drugs called immunosuppressants. They work by decreasing the activity of the immune system.
Cyclosporine comes as a capsule, an oral liquid solution, an intravenous (IV) injection and an eye drop. It is usually taken once or twice a day, depending on the particular product you are using.  This medication is available in its  original form and in a modified form that has been slightly changed to be more easily absorbed by the body.
Common side effects of cyclosporine oral and injectable include high blood pressure, gum overgrowth, and tremors. Cyclosporine eye drops commonly cause eye burnin g, itching, stinging or redness.
Cyclosporine is a prescription medication used to prevent transplant rejection in those who have received kidney, liver, and heart transplants.
Cyclosporine (modified) may also be used to treat psoriasis  symptoms of rheumatoid arthritis.
Cyclosporine ophthalmic emulsion is used to increase tear production in patients with chronic dry eye disease caused by inflammation.
This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.
Cyclosporine may be found in some form under the following brand names:
Cyclosporine is part of the drug class:
Common side effects of cyclosporine include:
Common side effects of cyclosporine eye drops include:
Tell your doctor if any side effect is bothersome or does not go away. Cyclosporine may cause other side effects. Call your doctor if you have any unusual problems while using this medication.
Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:
This is not a complete list of cyclosporine drug interactions. Ask your doctor or pharmacist for more information.
Grapefruit and grapefruit juice may interact with cyclosporine and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor.
Your doctor may tell you to limit the amount of potassium in your diet. Follow these instructions carefully. Talk to your doctor about the amount of potassium-rich foods such as bananas, prunes, raisins, and orange juice you may have in your diet. Many salt substitutes contain potassium, so talk to your doctor about using them during your treatment.
Before using cyclosporine, tell your doctor about all of your medical conditions including:
Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.
Do not have vaccinations without talking to your doctor.
Tell your doctor if you are pregnant or plan to become pregnant.
The FDA categorizes medications based on safety for use during pregnancy. Five categories – A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.
Cyclosporine falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.
Tell your doctor if you are breastfeeding or plan to breastfeed. It is not known if cyclosporine is excreted in human breast milk or if it will harm your nursing baby.
Cyclosporine comes as a capsule and a solution (liquid) to take by mouth. Sandimmune (cyclosporine) is usually taken once a day. Neoral (cyclosporine modified) is usually taken twice a day. It is important to take cyclosporine on a regular schedule. Take cyclosporine at the same time(s) each day, and allow the same amount of time between doses and meals every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take cyclosporine exactly as directed. Do not take more or less of the medication or take it more often than prescribed by your doctor.
You may notice an unusual smell when you open a blister card of cyclosporine capsules. This is normal and does not mean that the medication is damaged or unsafe to use.
Neoral (cyclosporine modified) oral solution may gel or become lumpy if it is exposed to temperatures below 68 °F (20 °C). You can use the solution even if it has gelled, or you can turn the solution back to a liquid by allowing it to warm to room temperature (77 °F [25 °C]).
Cyclosporine oral solution must be mixed with a liquid before use. Neoral (cyclosporine modified) oral solution may be mixed with orange juice or apple juice but should not be mixed with milk. Sandimmune (cyclosporine) oral solution may be mixed with milk, chocolate milk, or orange juice. You should choose one drink from the appropriate list and always mix your medication with that drink.
To take either type of oral solution, follow these steps:
To instill the eye drops, follow these steps :
If you take too much cyclosporine, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.
If cyclosporine is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.
Only physicians experienced in immunosuppressive therapy and management of organ transplant patients should prescribe Sandimmune® (cyclosporine). Patients receiving the drug should be managed in facilities equipped and staffed with adequate laboratory and supportive medical resources. The physician responsible for maintenance therapy should have complete information requisite for the follow-up of the patient.
Sandimmune (cyclosporine) should be administered with adrenal corticosteroids but not with other immunosuppressive agents. Increased susceptibility to infection and the possible development of lymphoma may result from immunosuppression.
Sandimmune Soft Gelatin Capsules (cyclosporine capsules, USP) and Sandimmune Oral Solution (cyclosporine oral solution, USP) have decreased bioavailability in comparison to Neoral Soft Gelatin Capsules (cyclosporine capsules, USP) MODIFIED and Neoral Oral Solution (cyclosporine oral solution, USP) MODIFIED.
Sandimmune and Neoral are not bioequivalent and cannot be used interchangeably without physician supervision.
The absorption of cyclosporine during chronic administration of Sandimmune Soft Gelatin Capsules and Oral Solution was found to be erratic. It is recommended that patients taking the soft gelatin capsules or oral solution over a period of time be monitored at repeated intervals for cyclosporine blood concentrations and subsequent dose adjustments be made in order to avoid toxicity due to high concentrations and possible organ rejection due to low absorption of cyclosporine. This is of special importance in liver transplants. Numerous assays are being developed to measure blood concentrations of cyclosporine. Comparison of concentrations in published literature to patient concentrations using current assays must be done with detailed knowledge of the assay methods employed.

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