Neoral Side Effects

Generic name: cyclosporine

Medically reviewed by Drugs.com. Last updated on Dec 17, 2024.

Note: This document provides detailed information about Neoral Side Effects associated with cyclosporine. Some dosage forms listed on this page may not apply specifically to the brand name Neoral.

Applies to cyclosporine: oral capsule, oral capsule liquid filled, oral solution.

Other dosage forms:

• intravenous solution

Important warnings This medicine can cause some serious health issues

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 Neoral

Along with its needed effects, cyclosporine (the active ingredient contained in Neoral) 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 side effects

• back pain
• black, tarry stools
• blurred vision
• chest pain
• chills
• clay colored stools
• cloudy urine
• cough
• dark urine
• decrease in urine output or decrease in urine-concentrating ability
• decreased appetite
• dizziness
• drowsiness
• fever
• headache
• headache, severe and throbbing
• itching
• loss of appetite
• muscle spasms (tetany) or twitching
• nausea and vomiting
• nervousness
• painful or difficult urination
• pounding in the ears
• shakiness in the legs, arms, hands, or feet
• skin rash
• slow or fast heartbeat
• sore throat
• sores, ulcers, or white spots on the lips or in the mouth
• stomach pain or tenderness
• swelling of the feet or lower legs
• swollen glands
• trembling or shaking of the hands or feet
• trouble breathing
• unusual bleeding or bruising
• unusual tiredness or weakness
• yellow eyes or skin

Less common side effects

• bleeding gums
• blood in the urine
• blood in the vomit
• burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
• chest tightness
• difficulty swallowing
• hives
• pale skin
• pinpoint red spots on the skin
• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• seizures
• severe or continuing stomach pain

Rare side effects

• bloating
• chest discomfort
• constipation
• darkened urine
• hoarseness
• indigestion
• lower back or side pain
• night sweats
• pain or discomfort in the arms, jaw, back, or neck
• pains in the stomach, side, or abdomen, possibly radiating to the back
• sweating
• vomiting of blood or material that looks like coffee grounds

Other side effects of Neoral

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 side effects

• bleeding, tender, or enlarged gums
• blemishes on the skin
• increased hair growth, especially on the face
• pain or tenderness around the eyes and cheekbones
• pimples
• stomach discomfort
• stuffy or runny nose

Less common side effects

• brittle fingernails
• burning feeling in the chest or stomach
• burning, dry, or itching eyes
• continuing ringing or buzzing or other unexplained noise in the ears
• cramps
• discharge or excessive tearing
• feeling of warmth
• hearing loss
• redness of the face, neck, arms, and occasionally, upper chest
• redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
• swelling of the breasts or breast soreness in both females and males
• weight loss

Rare side effects

• blurred or loss of vision
• discouragement
• disturbed color perception
• double vision
• fear
• feeling sad or empty
• halos around lights
• irritability
• joint pain
• loss of interest or pleasure
• night blindness
• overbright appearance of lights
• trouble concentrating
• trouble sleeping
• tunnel vision
• unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
• weight loss

For healthcare professionals

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

Cardiovascular adverse events

• 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]

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

Hematologic

• 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]

Hypersensitivity

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

Immunologic

• 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]

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]

Musculoskeletal

• 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]

Ocular

• 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]

Metabolic

• 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]

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]

Psychiatric

• 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]

Genitourinary

• 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]

Hepatic

• 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]

Oncologic

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

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

Respiratory

• 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]

Other

• 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]

Renal

• 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]

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]

Dermatologic

• 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]

Endocrine

• Common (1% to 10%): Dysmenorrhea, amenorrhea, goiter
• Uncommon (0.1% to 1%): Gynecomastia, leucorrhea
• Rare (less than 0.1%): Menstrual disorder^[Ref]

Gastrointestinal

• 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

• What is the difference between Cequa and Restasis?

Further information

Neoral side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

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