Skip to Content
Diagnosed with PsA? Learn about biologics >

cyclosporine

Generic Name: cyclosporine (SYE kloe SPOR een)
Brand Name: Gengraf, Neoral, SandIMMUNE

What is cyclosporine?

Cyclosporine lowers your body's immune system. The immune system helps your body fight infections. The immune system can also fight or "reject" a transplanted organ such as a liver or kidney. This is because the immune system treats the new organ as an invader.

Cyclosporine is used to prevent organ rejection after a kidney, heart, or liver transplant. Cyclosporine is also used to treat severe psoriasis or severe rheumatoid arthritis.

Cyclosporine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about cyclosporine?

Cyclosporine may increase your risk of developing serious infections, cancer, or transplant failure. Talk with your doctor about the risks and benefits of using this medication.

You may not be able to use this medicine if you have kidney disease, untreated or uncontrolled hypertension (high blood pressure), any type of cancer, or psoriasis that has been treated with PUVA, UVB, radiation, methotrexate (Trexall), or coal tar. MAKE SURE ALL DOCTORS INVOLVED IN YOUR CARE KNOW YOU ARE TAKING CYCLOSPORINE.

Cyclosporine can cause serious side effects, including kidney failure or life-threatening infection. While using cyclosporine, you will need frequent blood tests to be sure cyclosporine is not causing harmful effects.

What should I discuss with my health care provider before taking cyclosporine?

You should not use cyclosporine if you are allergic to it. You may not be able to use cyclosporine if you have:

  • kidney disease;

  • untreated or uncontrolled high blood pressure; or

  • any type of cancer.

If you are being treated for psoriasis, you should not receive ultraviolet light therapy (PUVA or UVB), radiation treatments, coal tar, or drugs that weaken the immune system (such as methotrexate) while you are receiving cyclosporine.

Cyclosporine can lower blood cells that help your body fight infections, or cause your body to produce too much of a certain type of white blood cells. This can lead to serious and sometimes fatal conditions, including cancer, a severe brain infection that can lead to disability or death, or a virus that can cause failure of a transplanted kidney. Talk with your doctor about your specific risk.

MAKE SURE ALL DOCTORS INVOLVED IN YOUR CARE KNOW YOU ARE TAKING CYCLOSPORINE.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Cyclosporine can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using cyclosporine.

How should I take cyclosporine?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

You may take cyclosporine with or without food, but take it the same way each time. Cyclosporine should be given in two separate doses each day. Try to take the medication at the same dosing times each day.

If your doctor changes your brand, strength, or type of cyclosporine, your dosage needs may change. Ask your pharmacist if you have any questions about the new kind of cyclosporine you receive at the pharmacy.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one. Sandimmune oral solution may be mixed with milk, chocolate milk, or orange juice at room temperature to make the medicine taste better. Neoral "modified" (microemulsion) oral solution should be mixed with orange juice or apple juice that is at room temperature.

While using cyclosporine, you will need frequent blood or urine tests to be sure cyclosporine is not causing harmful effects.

Your condition may need to be treated with a combination of different drugs. Use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication. Do not change your doses or medication schedule without your doctor's advice. Every person taking cyclosporine should remain under the care of a doctor.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking cyclosporine?

Grapefruit and grapefruit juice may interact with cyclosporine and lead to unwanted side effects. Avoid the use of grapefruit products while taking cyclosporine.

Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.

Do not receive a "live" vaccine while using cyclosporine. The vaccine may not work as well during this time, and may not fully protect you from disease. Live vaccines include measles, mumps, rubella (MMR), polio, rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

Avoid exposure to sunlight or tanning beds. Cyclosporine can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Cyclosporine side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • change in your mental state, problems with speech or walking, decreased vision (may start gradually and get worse quickly);

  • easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

  • pale or yellowed skin, dark colored urine, fever, confusion or weakness;

  • dangerously high blood pressure--severe headache, blurred vision, pounding in your neck or ears, nosebleed, anxiety, confusion, severe chest pain, shortness of breath, irregular heartbeats;

  • high potassium--nausea, slow or unusual heart rate, weakness, loss of movement;

  • kidney problems--little or no urinating, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath;

  • liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or

  • signs of infection--fever, chills, flu-like symptoms, mouth sores, skin sores, feeling light-headed or short of breath, rapid heart rate.

Common side effects may include:

  • tremors or shaking;

  • acne, increased growth of facial or body hair;

  • increased blood pressure;

  • nausea, diarrhea; or

  • swollen or painful gums.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Side effects (in more detail)

Cyclosporine dosing information

Usual Adult Dose for Organ Transplant -- Rejection Prophylaxis:

ORAL FORMULATION (MODIFIED):
Initial dose: Give 4 to 12 hours prior to transplantation or postoperatively; the initial dose varies depending on the organ and concomitant immunosuppressives
NEWLY TRANSPLANTED PATIENTS:
-Renal: 9 mg/kg/day (plus or minus 3 mg/kg/day) orally in 2 divided doses
-Liver: 8 mg/kg/day (plus or minus 4 mg/kg/day) orally in 2 divided doses
-Heart: 7 mg/kg/day (plus or minus 3 mg/kg/day) orally in 2 divided doses
COMMENTS:
-Titrate the dose based on rejection and tolerability.
-Lower doses of the modified formulation may be sufficient as maintenance therapy.
-Adjunct therapy with adrenal corticosteroids is recommended initially. Consult local protocol and/or manufacturer product information.

ORAL FORMULATION (NON-MODIFIED):
NOTE: The dosing presented here is to be used as a guideline only. Local protocol should be consulted for specific dosing for the non-modified formulations. Dosing in clinical practice may be very different than the manufacturer labeling. Non-modified formulations have decreased bioavailability in comparison to modified formulations. Modified and non-modified formulations are not bioequivalent and cannot be used interchangeably without physician supervision.
Manufacturer recommendation:
-Initial dose: 15 mg/kg orally 4 to 12 hours prior to transplantation; although a single dose of 14 to 18 mg/kg was used in most clinical trials, most clinicians favor the lower end of the scale. Lower initial doses are usually used for renal transplantation in the ranges of 10 to 14 mg/kg/day
-Maintenance dose: The initial single daily dose is continued postoperatively for 1 to 2 weeks and then tapered by 5% per week to a maintenance dose of 5 to 10 mg/kg/day; some clinicians prefer to reduce the maintenance dose to 3 mg/kg/day in some renal transplant patients without an apparent rise in rejection rate

PARENTERAL:
Note: Anaphylactic reactions have occurred with the IV formulation possibly due to the polyoxyethylated castor oil used as the vehicle.
-Initial dose: 5 to 6 mg/kg/day IV (or one-third of the oral dose) as a single dose infused over 2 to 6 hours given 4 to 12 hours prior to transplantation
-Maintenance dose: 5 to 6 mg/kg/day IV continued postoperatively until the patient can tolerate capsules or oral solution
COMMENTS:
-Most experts advise that the IV formulation should be reserved for patients who are unable to take the capsules or oral solution.
-Adjunct steroid therapy is to be used with this drug. Consult manufacturer product information and/or local protocol as the dose regimen varies.

Uses: For the prophylaxis of organ rejection in kidney, liver, and heart allogeneic transplants concomitantly with adrenal corticosteroids and in the treatment of chronic rejection in patients previously treated with other immunosuppressive agents

Usual Adult Dose for Rheumatoid Arthritis:

ORAL FORMULATION (MODIFIED):
-Initial dose: 2.5 mg/kg/day orally in 2 divided doses; onset of action usually occurs between 4 and 8 weeks
-Maintenance dose: If insufficient benefit is seen and tolerability is good at the initial dose (including serum creatinine less than 30% above baseline), the dose may be increased by 0.5 to 0.75 mg/kg/day after 8 weeks and again after 12 weeks
-Maximum dose: 4 mg/kg/day orally in 2 divided doses; if no benefit is seen by 16 weeks, therapy should be discontinued
COMMENTS:
-Salicylates, nonsteroidal anti-inflammatory agents, and oral corticosteroids may be continued concomitantly with this drug.
-Dose decreases by 25% to 50% should be made at any time to control adverse events (e.g., hypertension, elevations in serum creatinine 30% above pretreatment level), or significant laboratory abnormalities.
-Most patients can be treated with the modified formulation at doses of 3 mg/kg/day or below when combined with methotrexate doses of up to 15 mg/week.

Use: For severe active, rheumatoid arthritis where the disease has not adequately responded to methotrexate; this drug can be used in combination with methotrexate in rheumatoid arthritis patients who do not respond adequately to methotrexate alone

Usual Adult Dose for Psoriasis:

ORAL FORMULATION (MODIFIED):
-Initial dose: 1.25 mg/kg orally 2 times a day for at least 4 weeks
-Maintenance dose: If insufficient benefit is seen at 4 weeks and tolerability is good at the initial dose, the dose may be increased by 0.5 mg/kg/day at 2-week intervals based on patient response
-Maximum dose: 4 mg/kg/day in 2 divided doses
COMMENTS:
-Improvement is usually seen in 2 weeks. Stabilization of the psoriasis may take 12 to 16 weeks.
-Discontinue therapy if a satisfactory response cannot be achieved after 6 weeks at 4 mg/kg/day or the maximum tolerated dose.
-When a patient appears stable the dose should be lowered, and the patient treated with the lowest dose that maintains an adequate response (not necessarily a complete response).
-Doses at the lower end of the recommended range are effective in maintaining a satisfactory response in 60% of the patients. Doses below 2.5 mg/kg/day may also be equally effective.
-Dose decreases by 25% to 50% should be made at any time to control adverse events (e.g., hypertension, elevations in serum creatinine 25% or more above pretreatment level), or significant laboratory abnormalities.
-Discontinue therapy if dose reduction is not effective or if the adverse event is severe.
-Most patients will experience relapse of their psoriasis upon cessation of therapy.
-Long term experience in psoriasis patients is limited; therefore, therapy beyond one year is not recommended. Alternating with other forms of therapy should be considered in the long-term management of psoriasis.

Use: For nonimmunocompromised patients with severe (i.e., extensive and/or disabling), recalcitrant, plaque psoriasis who have failed to respond to at least one systemic therapy (e.g., PUVA, retinoids, or methotrexate) or in patients for whom other systemic therapies are contraindicated, or cannot be tolerated

Usual Pediatric Dose for Organ Transplant -- Rejection Prophylaxis:

One year and older:
The same dose and dosing regimen may be used in children as in adults although in several studies, children have required and tolerated higher doses than adults. Consult the manufacturer product information/and or local protocol.
ORAL FORMULATION (MODIFIED):
Initial dose: Give 4 to 12 hours prior to transplantation or postoperatively; the initial dose varies depending on the organ and concomitant immunosuppressives
NEWLY TRANSPLANTED PATIENTS:
-Renal: 9 mg/kg/day (plus or minus 3 mg/kg/day) orally in 2 divided doses
-Liver: 8 mg/kg/day (plus or minus 4 mg/kg/day) orally in 2 divided doses
-Heart: 7 mg/kg/day (plus or minus 3 mg/kg/day) orally in 2 divided doses
COMMENTS:
-Titrate the dose based on rejection and tolerability.
-Lower doses of the modified formulation may be sufficient as maintenance therapy.
-Adjunct therapy with adrenal corticosteroids is recommended initially. Consult local protocol and/or manufacturer product information.

ORAL FORMULATION (NON-MODIFIED):
NOTE: The dosing presented here is to be used as a guideline only. Local protocol should be consulted for specific dosing for the non-modified formulations. Dosing in clinical practice may be very different than the manufacturer labeling. Non-modified formulations have decreased bioavailability in comparison to modified formulations. Modified and non-modified formulations are not bioequivalent and cannot be used interchangeably without physician supervision.
Manufacturer recommendation:
-Initial dose: 15 mg/kg orally 4 to 12 hours prior to transplantation; although a single dose of 14 to 18 mg/kg was used in most clinical trials, most clinicians favor the lower end of the scale. Lower initial doses are usually used for renal transplantation in the ranges of 10 to 14 mg/kg/day
-Maintenance dose: The initial single daily dose is continued postoperatively for 1 to 2 weeks and then tapered by 5% per week to a maintenance dose of 5 to 10 mg/kg/day; some clinicians prefer to reduce the maintenance dose to 3 mg/kg/day in some renal transplant patients without an apparent rise in rejection rate

PARENTERAL:
Note: Anaphylactic reactions have occurred with the IV formulation possibly due to the polyoxyethylated castor oil used as the vehicle.
-Initial dose: 5 to 6 mg/kg/day IV (or one-third of the oral dose) as a single dose infused over 2 to 6 hours given 4 to 12 hours prior to transplantation
-Maintenance dose: 5 to 6 mg/kg/day IV continued postoperatively until the patient can tolerate capsules or oral solution
COMMENTS:
-Most experts advise that the IV formulation should be reserved for patients who are unable to take the capsules or oral solution.
-Adjunct steroid therapy is to be used with this drug. Consult manufacturer product information and/or local protocol as the dose regimen varies.

Uses: For the prophylaxis of organ rejection in kidney, liver, and heart allogeneic transplants concomitantly with adrenal corticosteroids and in the treatment of chronic rejection in patients previously treated with other immunosuppressive agents

What other drugs will affect cyclosporine?

Cyclosporine can harm your kidneys. This effect is increased when you also use certain other medicines, including: antivirals, cholesterol-lowering drugs, chemotherapy, injected antibiotics, medicine for bowel disorders, medicines to treat autoimmune disorders, medicine to prevent organ transplant rejection, stomach acid reducers (Tagamet, Zantac), and some pain or arthritis medicines (including aspirin, Tylenol, Advil, and Aleve).

Many drugs can interact with cyclosporine. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any you start or stop using, especially:

  • ambrisentan or bosentan;

  • dabigatran;

  • rifabutin;

  • St. John's wort;

  • antibiotic or antifungal medicine;

  • antiviral medicine to treat hepatitis C or HIV/AIDS;

  • birth control pills;

  • cholesterol-lowering medication:

  • heart or blood pressure medication, including a diuretic or "water pill";

  • seizure medication; or

  • steroid medication (oral, nasal, inhaled, or injectable).

This list is not complete and many other drugs can interact with cyclosporine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about cyclosporine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 6.01.

Date modified: November 15, 2017
Last reviewed: September 14, 2015

Hide