Generic name: cyclosporine [ SYE-kloe-SPOR-een ]
Brand names: Gengraf, Neoral, SandIMMUNE
Drug class: Calcineurin inhibitors
What is Neoral?
Neoral 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.
Neoral is used to prevent organ rejection after a kidney, heart, or liver transplant. This medicine is also used to treat severe psoriasis or severe rheumatoid arthritis.
Neoral may also be used for purposes not listed in this medication guide.
Neoral 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 Neoral 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 Neoral.
Neoral can cause serious side effects, including kidney failure or life-threatening infection. While using this medicine, you will need frequent blood tests to be sure this medicine is not causing harmful effects.
Before taking this medicine
You should not use Neoral if you are allergic to it. You may not be able to use this medicine if you have:
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 Neoral.
Neoral 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 Neoral.
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 Neoral?
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 Neoral in larger or smaller amounts or for longer than recommended.
You may take Neoral with or without food, but take it the same way each time. This medicine 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 Neoral, you will need frequent blood or urine tests to be sure this medicine 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 Neoral 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 Neoral?
Grapefruit and grapefruit juice may interact with Neoral and lead to unwanted side effects. Avoid the use of grapefruit products while taking this medicine.
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 Neoral. 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. Neoral can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.
Neoral 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.
What other drugs will affect Neoral?
Neoral 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 Neoral. 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;
antibiotic or antifungal medicine;
antiviral medicine to treat hepatitis C or HIV/AIDS;
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 Neoral. 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.
Both Cequa and Restasis are eye drops that contain cyclosporine. They are used to increase tear production in patients with dry eye disease (medically called keratoconjunctivitis sicca). However, Cequa incorporates a novel nanomicellar technology of cyclosporine A to allow delivery of high concentrations of the medication into the eye. Restasis is not manufactured using nanomicellar technology. Nanomicellar technology can help deliver poorly water-soluble drugs into the eye and protect the drug molecule. Continue reading
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