Cyclosporine (Neoral)
Cyclosporine is a medication that treats rheumatic diseases by suppressing the immune system.
Cyclosporine is used to treat several different types of arthritis, as well as immune disorders of the eyes, lungs, muscles, skin, nerves, and blood vessels. Cyclosporine is also used to help prevent organ rejection in transplant patients.
Cyclosporine works by reducing the activity of T-cells, a type of white blood cell that plays an important part in the body’s immune system.
Taking Cyclosporine
Cyclosporine is available in 25, 50, and 100 mg oral capsules, as well as a liquid oral suspension.
The normal dose of Cyclosporine is between 50 and 150 mg taken twice per day. The dose is based on the patient’s body weight (2.5mg per kilogram of body weight per day).
Doses should be spaced 12 hours apart.
It can take 3 to 4 months for the Cyclosporine to work. It is important for people starting this medication to be patient and to keep taking it as prescribed.
Important Tests and Risks
Patients taking Cyclosporine should get their blood and urine tested regularly (every two weeks to every month).
It is important for doctors to make sure that Cyclosporine is not affecting blood counts or harming the kidneys or liver.
Patients starting Cyclosporine should have their blood pressure checked every week for the first month of therapy, and then every month after that, for as long as they are taking the medicine.
Cyclosporine can make it a bit harder for people to fight off infections.
People taking this medicine should call their doctor they have a fever, think they have an infection, or have been prescribed antibiotics to treat an infection.
It’s important for patients to coordinate with their doctors and stop treatment before any surgery. Treatment can be re-started once things have healed and there’s no sign of infection.
Patients should discuss all vaccinations with their doctor because some are not advisable to get while taking Cyclosporine.
Several prescription medications which can interact with Cyclosporine.
Patients should make sure that their doctor knows every medicine and supplement that they are taking.
Common over-the-counter medications including cold remedies, pain medication, cough syrup, and laxatives are not known to interact with Cyclosporine.
It is not known how Cyclosporine could interact with most herbal medications. Patients should NOT use Echinacea as it appears to increase the risk of kidney side effects.
Cyclosporine should not be taken with grapefruit juice because it interferes with the absorption of the medication.
It is recommended that patients taking Cyclosporine drink 8 to 10 glasses of water per day (1.5 liters) to help their kidney function.
Science
Cyclosporine works by reducing the activity of T-cells, a type of white blood cell that plays an important part in the body’s immune system.
Cyclosporine binds to a protein cyclophilin (immunophilin) found on the surface of white blood cells, especially T-cells. This triggers a chain of reactions that reduces the function of these cells.
In preventing T-cells from working normally, Cyclosporine suppresses a part of the body’s immune system. Although this suppression may make it slightly harder for patients to fight off infections, it also helps to stabilize an overactive immune system.
Safety
Cyclosporine can irritate the liver. Regular blood tests are important for doctors to monitor blood counts and make sure that the liver or kidneys are not being harmed. Patients should drink 8-10 glasses of water per day to flush the kidneys.
MINOR side-effects include:
- Nausea, bloating, abdominal cramps, and diarrhea.
- Fatigue, weakness, muscle cramps, tremors, and flushing
- Headaches
- Tingling in the fingers, toes, tip of the nose, tongue, or lips.
- Increased hair growth on the arms, back of the hands, above the lip, or on the side of the face
- Tender, swollen, or bleeding gums
- Swelling of the ankles – Patients should tell their doctor if they experience this side effect
RARE side-effects include:
- Kidneys – Cyclosporine may affect kidney function. Kidney function is monitored closely with blood tests while you are taking Cyclosporine. When monitored closely, any change in kidney function is usually reversible by reducing the dose or stopping the Cyclosporine.
- High Blood Pressure –Cyclosporine may cause an increase in blood pressure. If this should happen, the dose of your Cyclosporine may be adjusted or a medication to control your blood pressure may be prescribed.
- Infection – Any infections or fevers should be taken seriously and reviewed by your doctor.
- Liver – Cyclosporine may irritate the liver. This does not usually cause symptoms but may be found on blood tests. It is rare and usually reversible when regularly monitored with your monthly blood tests.
- Malignancy – When used for long periods of time, Cyclosporine may be associated with a small increased risk of lymphoma and skin cancers. These cancers may be reversible when the medication is stopped.
How to minimize the side-effects of Cyclosporine:
- Regular monitoring is important. Patients should take Cyclosporine as prescribed, get regular blood tests, and attend all appointments with their doctor.
- Patients should drink 8 to 10 glasses of water per day (1.5 liters) to help kidney function.
- Patients should report any infections to their doctor.
Patients should talk to their doctor if they are concerned about any side effects when taking Cyclosporine.
Cyclosporine is felt to be safe in pregnancy. However, anyone who becomes pregnant while taking Cyclosporine should let their doctor know.
People who should NOT take Cyclosporine include:
- Patients who have had a previous serious reaction to Cyclosporine
- Some patients with diseases of the liver or kidney
- Patients with uncontrolled high blood pressure
- Patients with active uncontrolled infections
- Possibly patients with a past history of cancer
- Patients with other diseases which affect the immune system (e.g. HIV)
People taking Cyclosporine should call a doctor if they feel sick and want to stop, or if they are concerned about any side effects.
Other reasons to call a doctor while taking Cyclosporine include:
- New high blood pressure
- Fever or possible infection
- Pregnant or planning pregnancy
- Severe new headache
- Upcoming surgery
Anyone who becomes pregnant while taking Cyclosporine should notify their doctor immediately.
Pregnancy and medicationsVideo
Watch Dr. Andy Thompson, a Canadian rheumatologist, introduce Cyclosporine in this short video: