Sandoz Cyclosporine

Brand Name:Apo-Cyclosporine, Neoral, Sandimmune

Prescription needed: Yes

What is this drug used for?

Cyclosporine is most commonly used to prevent the body from rejecting organs that have been transplanted (for example, liver, kidney, pancreas, heart and bone marrow). It works by preventing the body’s own immune system from damaging the transplanted organ.

Cycolsporine is occasionally used for other conditions where the body’s own immune system is causing problems, such as in psoriasis, rheumatoid arthritis or nephrotic syndrome.

Is there any reason not to take this drug?

You should not use this drug if you are allergic to it.

Before taking this medication, tell your doctor specifically if you have or have ever had:

  • high blood pressure
  • problems with your kidney or liver
  • chicken pox or shingles (herpes zoster)
  • problems with frequent infections
  • low levels of magnesium in the blood
  • high levels of potassium in the blood
  • high levels of cholesterol in the blood
  • used other therapies for psoriasis like PUVA, UVB, radiation therapy, or other medications that decrease the immune system
  • seizures
  • high levels of uric acid in the blood or a condition called Gout
  • other cancers

What about possible side effects?

The most common and sometimes serious side effects of cyclosporine involve the kidney, blood, stomach and the nerves. These side effects are usually related to the dose and duration of therapy. These include:

  • high blood pressure
  • problems with the kidney
  • shaking hands (tremor) or tingling of the hands and feet
  • liver problems (contact your doctor if you experience unexplained nausea, vomiting, stomach pain, fatigue, loss of appetite, dark urine, yellowing of the skin and/or eyes)
  • headache
  • high levels of cholesterol, potassium and uric acid in the blood
  • low levels of magnesium in the blood
  • nausea, vomiting, not feeling hungry, pain in the stomach
  • increased body hair
  • swelling of the gums
  • pain or cramps in the muscles
  • feeling tired

Less common and some severe side effects include:

  • seizures
  • problems with vision
  • feeling confused
  • a condition called thrombocytopenia, anemia or leukopenia; usually associated with long-term therapy or in people who have risk factors - contact your doctor immediately if you experience unusual bleeding, bruising, unexplained sore throat, fever, chills, or other signs of infection
  • increased chance for some cancers - rare and with longer-term therapy, with other drugs that can change the body’s immune system or with other risk factors
  • swelling of the feet or ankles
  • rash
This is not a complete list of side effects. If you are concerned about these or other unusual symptoms while taking this medication, ask your doctor and/or pharmacist for more information and advice.

What if I am taking other drugs?

Always provide your doctor with a list of all other drugs you are taking (including over-the-counter medications and herbal/natural products) as they may interact with and/or change the safety or effectiveness of either drug. Tell your doctor specifically if you are taking any of these drugs as he/she may need to make changes or monitor you more closely:
  • potassium supplements, ACE-inhibitors [e.g. ramipril, enalapril, lisinopril], valsartan, losartan, candesartan, amiloride, spironolactone, triamterene - may increase the chances of having high levels of potassium in the blood which may cause serious side effects
  • Itraconazole, ketoconazole, fluconazole, cimetidine, HIV protease inhibitors (e.g. ritonavir), amiodarone, clarithromycin, erythromycin, amlodipine, diltiazem, verapamil, allopurinol, estrogen-like drugs (e.g. birth control pills), steroid-like drugs (e.g. dexamethasone, prednisone) - may increase the amount of cyclosporine in your blood and increase your chances of side effects
  • carbamazepine, phenytoin, phenobarbital, St. John’s Wort, rifampin - may decrease the amount of cyclosporine in your blood
  • ASA and other anti-inflammatories (e.g. ibuprofen, voltaren, diclofenac) (e.g ibuprofen, naproxen, voltaren), colchicine, cotrimoxazole, ciprofloxaxcin - can increase the chances of problems with your kidney
  • Digoxin - may increase the amount of digoxin in the blood and increase the chance for side effects
  • If you are taking medication(s) to treat high blood pressure, this medication may interfere with how well your blood pressure medication can work and your blood pressure may increase; your doctor will likely check your blood pressure periodically while you are taking this medication
  • atorvastatin, lovastatin, simvastatin - may increase your chances of muscle side effects
  • azathioprine - may decrease the amount of cyclosporine in the blood and decrease how well it can work.
  • Nifedipine - increase chances of having swelling of the gums
  • Warfarin - need checking of both warfarin and cyclosporine
  • cyclophosphamide - may decrease the amount of cyclosporine in the blood
  • methotrexate - may increase the amount of methotrexate in the blood
  • tacrolimus
  • danazol
  • live vaccines - may increase the chances for infection
  • other vaccines - may decrease the body’s ability to develop immunity to the vaccine

This is not a complete list of drug interactions. Ask your doctor or pharmacist to review your list of medications.

Other information:

As this drug decreases how well your body’s immune system can work, you will become more susceptible to infections. Call your doctor if you have any signs of infection such as fever, sore throat, muscle aches, etc. while you are taking this medication. If you are exposed to chicken pox, measles or tuberculosis while taking this drug, tell your doctor.

Vaccines: Due to the increased risk of infection both during and after treatment with this drug, it is important not to have any vaccinations or skin tests without first talking to your doctor. Some vaccines are not recommended.

Family members living in the same household should not take oral polio vaccine because there is a chance they could pass the polio virus on to you. Also, avoid anyone who has recently taken oral polio vaccine.

Lab Tests and follow-up: It is extremely important that you have your blood tested as recommended by your doctor. These blood tests are necessary to make sure you have the right amount of drug in your body. This ensures that the drug works properly and decreases your chances of having side effects. Your doctor will also order regular blood tests to check your kidney and liver function.

In addition, your doctor will check your blood pressure on a regular basis because cyclosporine can increase your blood pressure. If you develop high blood pressure with this medication, your doctor may need to decrease your cyclosporine dose or prescribe you a medication to decrease your blood pressure.

Different Brands: Not all tablets, capsules or liquid of cyclosporine are equal. If you are given a different form of cyclosporine, be sure to let your healthcare provider know. Sometimes a change in dose may be necessary.

Children: Can be used; lower doses are necessary.

Seniors: Reduced dose may be necessary.

Pregnancy: Not usually prescribed. Talk to your doctor.

Women who are nursing: Not recommended. Talk to your doctor.

People who drive or operate machinery: No known problems.

Overdose: Call your doctor immediately. If you experience any unusual reactions or if you seriously exceed the recommended dosage, call your doctor or 911.

Stopping the drug: Always talk to your doctor before you stop taking this drug. Suddenly stopping treatment could cause rejection of a transplanted organ or skin graft.

If you miss a dose: Take as soon as you remember. If the dose is more than 36 hours late, let your healthcare provider know, especially if you are taking this medication to prevent organ rejection.

Storage conditions: Capsules should be left in the blister pack until needed. Keep in a cool (not cold) dry place out of the reach of children. If you are using a liquid formulation, do not refrigerate.

Alcohol: No known problems. If you drink, always drink in moderation.

Dietary precautions: Avoid grapefruit juice as it may increase the amount of cyclosporine in your blood. Do not take any potassium supplements.