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Gengraf Side Effects

Generic name: cyclosporine

Medically reviewed by Last updated on Dec 31, 2023.

Note: This document contains side effect information about cyclosporine. Some dosage forms listed on this page may not apply to the brand name Gengraf.

Applies to cyclosporine: oral capsule, oral capsule liquid filled, oral solution. Other dosage forms:


Oral route (Capsule; Capsule, Liquid Filled; Solution)

Only physicians experienced in immunosuppressive therapy and management of organ transplant patients should prescribe cyclosporine. Patients receiving the drug should be managed in facilities equipped and staffed with adequate laboratory and supportive medical resources. The physician responsible for maintenance therapy should have complete information requisite for the follow-up of the patient.Cyclosporine should be administered with adrenal corticosteroids but not with other immunosuppressive agents. Increased susceptibility to infection and the possible development lymphoma may result from immunosuppression.Cyclosporine capsules and cyclosporine solution have decreased bioavailability in comparison to cyclosporine MODIFIED capsules and cyclosporine MODIFIED solution.Cyclosporine and cyclosporine MODIFIED are not bioequivalent and cannot be used interchangeably without physician supervision.The absorption of cyclosporine during chronic administration of cyclosporine capsules and oral solution was found to be erratic. It is recommended that patients taking the soft gelatin capsules or oral solution over a period of time be monitored at repeated intervals for cyclosporine blood concentrations and subsequent dose adjustments be made in order to avoid toxicity due to high concentrations and possible organ rejection due to low absorption of cyclosporine. This is of special importance in liver transplants. Numerous assays are being developed to measure blood concentrations of cyclosporine. Comparisons of concentrations in published literature to patient concentrations using current assays must be done with detailed knowledge of the assay methods employed.

Oral route (Capsule, Liquid Filled; Solution)

Only physicians experienced in management of systemic immunosuppressive therapy for the indicated disease should prescribe cycloSPORINE, modified. Increased susceptibility to infection and the possible development of lymphoma may result from immunosuppression. Hypertension and nephrotoxicity can occur at recommended dosages, and the risk increases with increasing dose and duration of cycloSPORINE therapy. Monitor blood levels and renal function to avoid toxicity. CycloSPORINE, modified (Neoral® or Gengraf®) and cycloSPORINE (Sandimmune®) are not bioequivalent and cannot be used interchangeably without physician supervision. Psoriasis patients previously treated with PUVA and to a lesser extent, methotrexate or other immunosuppressive agents, UV-B, coal tar, or radiation therapy, are at an increased risk of developing skin malignancies when taking cycloSPORINE.

Serious side effects of Gengraf

Along with its needed effects, cyclosporine (the active ingredient contained in Gengraf) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking cyclosporine:

More common

Less common


Other side effects of Gengraf

Some side effects of cyclosporine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Less common


For Healthcare Professionals

Applies to cyclosporine: compounding powder, injectable solution, oral capsule, oral liquid, oral solution.


Hypertension, usually mild to moderate, occurs in approximately 50% of patients following renal transplantation and in most cardiac transplant patients.[Ref]

Very common (10% or more): Hypertension (26%)

Common (1% to 10%): Flushing, arrhythmia, purpura, abnormal heart sounds, cardiac failure, peripheral ischemia

Rare (less than 0.1%): Hypertension with fluid retention and convulsions (mainly in children), chest pain, myocardial infarction[Ref]


Common (1% to 10%): Leukopenia

Uncommon (0.1% to 1%): Thrombocytopenia, anemia

Rare (less than 0.1%): Hemolytic uremic syndrome, microangiopathic hemolytic anemia

Frequency not reported: Thrombotic microangiopathy, thrombotic thrombocytopenic purpura, platelet/bleeding/clotting disorders, red blood cell disorder[Ref]


Common (1% to 10%): Allergic reactions[Ref]


Preexisting infections may be aggravated and reactivation of Polyomavirus infections may lead to Polyomavirus associated nephropathy (PVAN) or to JC virus associated progressive multifocal leukoencephalopathy (PML); serious and/or fatal outcomes have been reported.[Ref]

Common (1% to 10%): Increased susceptibility to infections, septicemia, abscess, systemic fungal infection, localized or generalized infections (viral, bacterial, fungal, parasitic), cytomegalovirus, wound and skin infections, cellulitis, folliculitis, herpes simplex, herpes zoster

Frequency not reported: JC virus-associated progressive multifocal leukoencephalopathy (PML) (sometimes fatal), polyoma virus-associated nephropathy (PVAN), BK virus resulting in graft loss[Ref]


Common (1% to 10%): Myalgia, muscle cramps, muscle pain

Rare (less than 0.1%): Muscle weakness, myopathy, joint pain, tingling

Frequency not reported: Pain of lower extremities, arthralgia, bone fracture, bursitis, joint dislocation, stiffness, synovial cyst, tendon disorder[Ref]


Common (1% to 10%): Conjunctivitis, visual disturbance, abnormal vision, cataract, eye pain

Very rare (less than 0.01%): Optic disc edema (including papilledema with possible visual impairment secondary to benign intracranial hypertension)[Ref]


Hypomagnesemia has been reported in some patients exhibiting convulsions while taking this drug. Although magnesium-depletion studies in normal subjects suggest that hypomagnesemia is associated with neurologic disorders, multiple factors, including hypertension, high dose methylprednisolone, hypocholesterolemia, and nephrotoxicity associated with high plasma concentrations of this drug appear to be related to the neurological toxicity.[Ref]

Very common (10% or more): Hyperlipidemia

Common (1% to 10%): Hyperglycemia, hypoglycemia, anorexia, hyperuricemia, hyperkalemia, hypomagnesemia, diabetes mellitus

Rare (less than 0.1%): Weight loss, weight gain[Ref]


Common (1% to 10%): Depression, insomnia

Uncommon (0.1% to 1%): Confusion, lethargy, depression, disorientation, decreased responsiveness, agitation, visual hallucinations

Rare (less than 0.1%): Anxiety

Frequency not reported: Libido decreased[Ref]


Very common (10% or more): Urinary tract infection (21%)

Common (1% to 10%): Dysuria, micturition frequency, hot flushes

Rare (less than 0.1%): Hematuria, gynecomastia

Frequency not reported: Increased BUN, abnormal urine, nocturia, polyuria[Ref]


Common (1% to 10%): Hepatic function abnormal, bilirubinemia

Frequency not reported: Hepatotoxicity (e.g., cholestasis, jaundice, hepatitis, liver failure [sometimes fatal])

Postmarketing reports: Cholestasis[Ref]


The frequency of malignancies increases with the intensity and duration of therapy and may be fatal.[Ref]

Frequency not reported: Lymphomas or lymphoproliferative disorders and other malignancies (particularly of the skin), breast fibroadenosis[Ref]


Common (1% to 10%): Pneumonia, bronchitis, coughing, dyspnea, pharyngitis, rhinitis, sinusitis, upper respiratory tract infection

Rare (0.01% to 0.1%): Respiratory distress syndrome

Frequency not reported: Bronchospasm[Ref]


Very common (10% or more): Fatigue, pyrexia

Common (1% to 10%): Lethargy, pain, rigors, malaise

Uncommon (0.1% to 1%): Hearing loss, tinnitus

Rare (less than 0.1%): Weakness

Frequency not reported: Deafness, taste perversion[Ref]

Nervous system

Very common (10% or more): Tremor (12%), headache, burning sensation in hands and feet (usually during the first week of therapy)

Common (1% to 10%): Convulsions, paresthesia, dizziness, paresthesia, hypoesthesia, neuropathy, vertigo

Uncommon (0.1% to 1%): Encephalopathy (including Posterior Reversible Encephalopathy Syndrome [PRES] manifested by convulsions, confusion, disorientation, decreased responsiveness, agitation, insomnia, visual disturbances, cortical blindness, coma, paresis, and cerebellar ataxia)

Rare (less than 0.1%): Motor polyneuropathy

Frequency not reported: Migraine[Ref]


The pathologic changes of glomerular capillary thrombosis resemble those seen in hemolytic-uremic syndrome including thrombosis of the renal microvasculature, with platelet-fibrin thrombi occluding glomerular capillaries and afferent arterioles, microangiopathic hemolytic anemia, thrombocytopenia, and decreased renal function. Similar findings have been observed when other immunosuppressants have been used post-transplantation.[Ref]

Very common (10% or more): Renal dysfunction (32%), elevated creatinine

Uncommon (0.1% to 1%): Renal failure (which may result in graft failure)

Frequency not reported: Glomerular capillary thrombosis[Ref]


Very common (10% or more): Hirsutism (21%)

Common (1% to 10%): Acne, hypertrichosis, brittle fingernails, hair breaking, alopecia, bullous eruption, skin ulceration, increased sweating, dry skin

Uncommon (0.1% to 1%): Allergic rashes, pruritus

Rare (less than 0.1%): Burning sensation, pigmentation, night sweats[Ref]


Common (1% to 10%): Dysmenorrhea, amenorrhea, goiter

Uncommon (0.1% to 1%): Gynecomastia, leucorrhea

Rare (less than 0.1%): Menstrual disorder[Ref]


Very common (10% or more): Gingival hyperplasia, GI disturbances (e.g., nausea, vomiting, diarrhea, abdominal pain/discomfort)

Common (1% to 10%): Peptic ulcer, acute pancreatitis, gastritis, hiccups, flatulence, gingivitis, stomatitis, dry mouth, dysphagia, enanthema, eructation, esophagitis, glossitis, gingival bleeding, salivary gland enlargement, tongue disorder, tooth disorder, abdominal distention, keratosis

Rare (less than 0.1%): Pancreatitis, gastroenteritis, asymptomatic hyperamylasemia, biliary calculous disease (associated with moderate or severe hepatotoxicity), constipation, mouth sores, upper GI bleeding, rectal hemorrhage[Ref]

Frequently asked questions


1. Product Information. SandIMMUNE (cycloSPORINE). Apothecon Inc. 2022.

2. Cerner Multum, Inc. UK Summary of Product Characteristics.

3. Cerner Multum, Inc. Australian Product Information.

4. Product Information. CycloSPORINE (cycloSPORINE). Teva Pharmaceuticals (formerly IVAX). PROD.

5. Product Information. CycloSPORINE Modified (cycloSPORINE). Sandoz Laboratories, Eon Division. 2022.

6. Product Information. Gengraf (cycloSPORINE). AbbVie US LLC. 2022.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.