Medications

Neoral

Neoral (Cyclosporine) is a medication that treats rheumatic diseases by suppressing the immune system.

Neoral is used to treat several different types of arthritis, as well as immune disorders of the eyes, lungs, muscles, skin, nerves, and blood vessels. Neoral is also used to help prevent organ rejection in transplant patients.

Neoral 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 Neoral

Neoral is available in 25, 50, and 100 mg oral capsules, as well as a liquid oral suspension.

Neoral – Administration, Dose, and Frequency

The normal dose of Neoral 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 Neoral to work. It is important for people starting this medication to be patient and to keep taking it as prescribed.

Important Tests and Risks

Regular Blood and Urine Tests

Patients taking Neoral should get their blood and urine tested regularly (every two weeks to every month).

It is important for doctors to make sure that Neoral is not affecting blood counts or harming the kidneys or liver.

Regular Blood Pressure Tests

Patients starting Neoral 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.

Risk of Infection

Neoral 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 Neoral.

Risk of Interaction with Medications

Several prescription medications which can interact with Neoral.

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 Neoral.

It is not known how Neoral could interact with most herbal medications. Patients should NOT use Echinacea as it appears to increase the risk of kidney side effects.

Avoid Grapefruit Juice

Neoral should not be taken with grapefruit juice because it interferes with the absorption of the medication.

Drink 8-10 Glasses of Water a Day

It is recommended that patients taking Neoral drink 8 to 10 glasses of water per day (1.5 liters) to help their kidney function.

Science

How Neoral Works

Neoral 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.

Neoral 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, Neoral 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

Side Effects

Neoral 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 – Neoral may affect kidney function. Kidney function is monitored closely with blood tests while you are taking Neoral. When monitored closely, any change in kidney function is usually reversible by reducing the dose or stopping the Neoral.
  • High Blood Pressure –Neoral may cause an increase in blood pressure. If this should happen, the dose of your Neoral 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 – Neoral 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, Neoral 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 Neoral:

  • Regular monitoring is important. Patients should take Neoral 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 Neoral.

Who Should NOT Take Neoral

People who should NOT take Neoral include:

  • Patients who have had a previous serious reaction to Neoral
  • 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)

When to Call a Doctor

People taking Neoral 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 Neoral include:

  • New high blood pressure
  • Fever or possible infection
  • Pregnant or planning pregnancy
  • Severe new headache
  • Upcoming surgery

Anyone who becomes pregnant while taking Neoral should notify their doctor immediately.

Video

Watch Dr. Andy Thompson, a Canadian rheumatologist, introduce Neoral in this short video: