Cyclosporine

Brand names

• Neoral
• Sandimmune
• SangCya

Usage

To slow down or reduce the natural tendency of the immune system to reject organ or bone marrow transplants. To treat severe rheumatoid arthritis or psoriasis that has not responded to other medicament therapy. Also used in steroid-resistant nephrotic syndrome.

How it works

Cyclosporine suppresses the functioning of the body's immune system. In this way it prevents the normal reaction against foreign substances or tissue that would otherwise cause the body to reject donor organs or bone marrow. Cyclosporine is also used to manage rheumatoid arthritis and psoriasis, as these disorders are classified as autoimmune diseases, that is, those in which the immune system inappropriately attacks healthy tissue.

Side effects

Serious

Frequent urge to urinate; fever or chills; yellow-tinged eyes and skin caused by liver problems; abnormal bleeding; fatigue; high blood pressure. Seek medical help immediately. Psoriasis patients formerly treated with other types of therapy (for example, ultraviolet light or methotrexate) are at increased risk of skin cancer; report any new skin lesion to your doctor immediately.

Common

Headache, tremor, unusual hair growth on body and face, swelling or bleeding of gums.

Less common

Nausea, vomiting, diarrhea, acne or oily skin, sinus inflammation or infection, leg cramps, enlargement and tenderness of the breasts in males (gynecomastia).

Possible interactions

Other medicaments:

Cyclosporine taken concurrently with:

• ACE inhibitors may increase the risk of kidney problems.
• aminoglycoside antibiotics may increase kidney toxicity.
• amphotericin B (Abelcet, others) can cause serious kidney toxicity.
• aspirin substitutes (nonsteroidal anti-inflammatory medicaments or NSAIDs) may increase kidney toxicity.
• azathioprine (Imuran) may increase immunosuppression.
• calcium channel blockers may result in cyclosporine toxicity.
• clonidine (Catapres) can increase risk of kidney problems.
• ciprofloxacin (and other fluoroquinolones) may increase risk of kidney toxicity.
• cotrimoxazole (Bactrlm, others) may result in decreased cyclosporine effectiveness as well as kidney toxicity.
• cyclophosphamide (Cytoxan) may increase immunosuppression.
• digoxin (Lanoxin) may result in serious digoxin toxicity.
• furosemide (Lasix) may result in increased risk of gout.
• ganciclovir (Cytovene) may result in increased kidney toxicity.
• histamine (H2) inhibitors and ketoconazole may experience decreased cyclosporine blood levels.
• imipenem/cilastatin (Primaxin) may result in neurotoxicity.
• lovastatin (Mevacor), atorvastatin (Lipitor) and other HMG-CoA reductase inhibitors may increase risk of muscle toxicity (myopathy) or kidney failure.
• methylprednisolone (Medrol) may cause seizures.
• metronidazole (Flagyl) may result in increased cyclosporine levels and toxicity.
• nifedipine (Adalat) may worsen abnormal gum growth (gingival hyperplasia) and also cause nifedipine toxicity (low blood pressure and abnormal heartbeats).
• propafenone (Rythmol) may increase risk of cyclosporine toxicity.
• pravastatin (Pravachol) can cause myopathy.
• saquinavir (Fortovase, Invirase) may increase risk of cyclosporine toxicity.
• simvastatin (Zocor) may cause myopathy.
• spironolactone (various) may increase risk of excessive potassium levels.
• sulfamethoxazole and/or trimethoprim (Septra) may increase kidney toxicity.
• tacrolimus (Prograf) can cause kidney toxicity.
• thiazide diuretics may increase adverse effects on the blood (myelosuppression).
• triamterine (various) may increase risk of excessive potassium levels.
• vaccines may blunt the benefit of the vaccine.
• valproic acid (Depakene, others) lead to liver toxicity in one patient.
• verapamil (Calan) may increase immunosuppression.

The following medicaments may increase the effects of cyclosporine:



• acetazolamide.
• allopurinol (Zyloprim).
• amiodarone (Cordarone).
• ceftriaxone (Rocephin).
• cimetidine (Tagamet).
• cisapride (Propulsid).
• clarithromycin (Biaxin).
• clotrimazole (Mycelex, Gyne-Lotrlmin, others).
• colchicine (Colbenemid).
• dalfopristin (Synercid).
• danazol or other anabolic steroids.
• diltiazem (Cardizem).
• econazole (Spectazole).
• erythromycin (E.E.S., others).
• fluconazole (Diflucan).
• fluvoxamine (Luvox).
• glipizide (Glucotrol) or glyburide (Diabeta).
• grepafloxacin (Raxar).
• itraconazole (Sporanox).
• ketoconazole (Nizoral).
• methotrexate (Rheumatrex).
• methyltestosterone.
• metoclopramide (Reglan).
• miconazole (Lotrimin, Micatin).
• nonsteroidal anti-inflammatory agents.
• oral contraceptives (birth control pills).
• ritonavir (Norvir).
• tamoxifen (Nolvadex).
• terconazole (Terazol).

The following medicaments may decrease the effects of cyclosporine:



• carbamazepine (Tegretol).
• carvedilol (Coreg).
• clindamycin (various).
• isoniazid (INH).
• nafcillin.
• octreotide(Sandostatin).
• orlistat (Xenical).
• omeprazole (Prilosec).
• phenobarbital.
• phenytoin (Dilantin) or fosphenytoin (Cerebyx).
• quinine.
• rifabutin (Mycobutin).
• rifampin (Rifadin).
• sulfadimidine, sulfadiazine and/or trimethoprim.
• ticlopidine (Ticlid).
• troglitazone (Rezulin).
• warfarin (Coumadin).

Foods:

Food may increase the peak blood level of cyclosporine.

Herbal medicines or minerals:

Some patients use Echinacea to attempt to boost their immune systems when they are ill. Use of Echinacea is not recommended in people taking medicines to suppress their immune systems. Do not take mistletoe herb, oak bark or marshmallow root and licorice. There have been case reports of heart transplant rejection with combined use of cyclosporine and St. John's wort. Do not combine these. Cyclosporine may deplete magnesium from the body. Ask your doctor if supplementation with magnesium makes sense for you. Potassium levels may be increased by cyclosporine. Avoid excessive intake of high potassium foods.

Beverages:

Grapefruit juice and other fruit juices increase blood levels. Milk may increase blood levels.

Alcohol:

Large amounts of alcohol may increase cyclosporine levels.

Exposure to sun:

Exposure to sunlight or other ultraviolet (UV) radiation may increase the risk of skin cancer.

Discontinuation:

Do not stop this medicament without your physician's guidance.

Special storage instructions:

Keep the gelatin capsules in the blister packets until ready for use. Store below 77 degrees F (25 degrees C). Keep the oral solution in a tightly closed container. Store below 86 degrees F (30 degrees C). Do not refrigerate.