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Cyclosporine Oral capsule, modified

It is used to decrease the immune system's response to a transplanted organ

Generic Name: cycloSPORINE  |  Brand Name: Sangcya

Brand Names: Sandimmune, Gengraf, Sangcya, Neoral

There is an FDA Alert for this drug. Click here to view it.

    Supervising Clinician and Medical Resources
  • Only clinicians experienced in management of systemic immunosuppressive therapy for the indicated disease and/or management of organ transplant patients should prescribe cyclosporine.
  • Patients should be managed in facilities with adequate laboratory and supportive medical resources; the clinician responsible for maintenance therapy should have complete information for patient follow-up.
    Effects of Immunosuppression
  • Immunosuppression may result in increased susceptibility to infection and possible development of lymphoma or other neoplasms. (See Lymphomas and Other Malignancies under Cautions.)
  • Manufacturer cautions that conventional (nonmodified) oral formulations and the concentrate for injection should be administered with corticosteroids but not with other immunosuppressive agents in organ transplant recipients. Manufacturers state that modified oral formulations of cyclosporine (Neoral® and Gengraf®) may be administered with oral immunosuppressive agents in transplant patients, although the degree of immunosuppression produced may result in increased susceptibility to infection and possible development of lymphoma and other neoplasms.
    Bioequivalency of Formulations
  • Conventional (nonmodified) oral formulations (Sandimmune® liquid-filled capsules and solution) have decreased bioavailability compared with modified oral formulations (Neoral® and Gengraf® liquid-filled capsules and solution). Conventional (nonmodified) and modified formulations are not bioequivalent and cannot be used interchangeably without physician supervision. (See Conversion from Conventional Oral Formulations [Sandimmune®] to Modified Oral Formulations [Gengraf®, Neoral®] under Dosage and Administration.)
  • Absorption of cyclosporine during chronic administration of Sandimmune® capsules and oral solution may be erratic. Patients, especially liver transplant recipients, receiving these formulations over a period of time should be monitored at repeated intervals for blood cyclosporine concentrations and possible organ rejection due to low absorption of cyclosporine.
  • For a given trough concentration, cyclosporine exposure will be greater with Neoral® or Gengraf® preparations than with Sandimmune® preparations. Exercise particular caution if a patient is receiving exceptionally high doses of Sandimmune® and is converted to Gengraf® or Neoral®. (See Conversion from Conventional Oral Formulations [Sandimmune®] to Modified Oral Formulations [Gengraf®, Neoral®] under Dosage and Administration.)
  • Patients receiving Gengraf® or Neoral® liquid-filled capsules or oral solution for organ transplant or in the management of rheumatoid arthritis should also have blood cyclosporine concentrations monitored to avoid toxicity due to high concentrations. (See Monitoring of Cyclosporine Concentrations under Cautions.)
    Psoriasis Patients
  • Previous therapy with psoralen and UVA light (PUVA) and, to a lesser extent, methotrexate, other immunosuppressive agents, UVB, coal tar, or radiation therapy may increase risk of skin malignancies in patients receiving cyclosporine.
  • Recommended dosages can cause hypertension and nephrotoxicity; risk increases with dose and duration of therapy. Monitor renal function (see General: Psoriasis, under Dosage and Administration).

What is this medicine?

CYCLOSPORINE (SYE kloe spor een) is used to decrease the immune system's response to a transplanted organ. The medicine is also used for rheumatoid arthritis and psoriasis.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
  • cancer
  • high blood pressure
  • immune system problems
  • infection
  • kidney disease
  • liver disease
  • previous coal tar, PUVA, ultraviolet, or radiation therapy
  • an unusual or allergic reaction to cyclosporine, alcohol, corn oil (Neoral only), castor oil, other medicines, foods, dyes, or preservatives
  • pregnant or trying to get pregnant
  • breast feeding

How should I use this medicine?

Take this medicine by mouth with a full glass of water. Do not take with grapefruit juice. Swallow the capsules whole. Do not chew or break the capsule. Follow the directions on the prescription label. Take your medicine at regular intervals. Take the capsules at the same time each day and at the same time in relation to meals. Do not take your medicine more often than directed. Do not stop taking except on your doctor's advice.

Talk to your pediatrician regarding the use of this medicine in children. While this drug may be prescribed for children as young as 1 year for selected conditions, precautions do apply.

Patients over 65 years old may have a stronger reaction and need a smaller dose.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses. Call your doctor or health care professional if you miss more than one dose or if you miss doses on a regular basis.

What may interact with this medicine?

Do not take this medicine with any of the following medications:
  • bosentan
  • cidofovir
  • cisapride
  • mibefradil
  • ranolazine
  • red yeast rice, monascus purpureus
  • St. John's wort
  • tacrolimus

This medicine may also interact with the following medications:

  • acyclovir
  • allopurinol
  • amiloride
  • amiodarone
  • bromocriptine
  • carbamazepine
  • certain antibiotics
  • cimetidine
  • colchicine
  • danazol
  • digoxin
  • female hormones, including contraceptive or birth control pills
  • imatinib
  • medicines for fungal infections like amphotericin B, fluconazole, itraconazole, terbinafine, and ketoconazole
  • medicines for blood pressure like diltiazem, nicardipine, verapamil, enalapril, ramipril, and losartan
  • medicines for cholesterol like lovastatin, simvastatin, atorvastatin, and fenofibrate
  • medicines for HIV infection like indinavir, nelfinavir, ritonavir, and saquinavir
  • medicines that suppress the immune system
  • melphalan
  • methotrexate
  • metoclopramide
  • NSAIDs, medicines for pain and inflammation, like ibuprofen or naproxen
  • octreotide
  • orlistat
  • oxcarbazepine
  • phenobarbital
  • phenytoin
  • ranitidine
  • sirolimus
  • spironolactone
  • steroid medicines like prednisone or cortisone
  • sulfinpyrazone
  • ticlopidine
  • triamterene
  • vaccines
  • voriconazole


Last Updated: July 13, 2009
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