Cyclosporine

The recommended dose of cyclosporine varies according to weight and circumstances.

For solid organ transplants, the recommended dose is 10 mg to 15 mg per kilogram of body weight daily (in 2 divided doses) starting at least 12 hours before surgery. The dose usually stays the same for 1 or 2 weeks after the operation and then is reduced gradually by the doctor so that a particular level of the medication in the bloodstream is reached.

For bone marrow transplants, the oral form of the medication is usually given as a daily dose of 12.5 mg to 15 mg per kilogram of body weight in 2 divided doses. This dose is usually continued for 3 to 6 months and then decreased gradually until it is stopped, about one year after the transplant.

For treatment of psoriasis, the recommended oral starting dose is 2.5 mg per kilogram of body weight per day in 2 divided doses. If no improvement is seen in one month, the doctor may increase the daily dose gradually. The daily dose of cyclosporine should not go above 5 mg per kilogram of body weight per day. If there is still no improvement after 6 weeks of treatment, the treatment should be stopped. If the psoriasis improves, the doctor may gradually decrease the dose. Psoriasis often returns once the medication is stopped, so the goal of treatment is usually to find the smallest dose that will be effective.

For treatment of rheumatoid arthritis, the recommended dose is 2.5 mg per kilogram of body weight per day in 2 divided doses for the first 6 weeks of treatment. If the desired improvement is not seen, the doctor may increase the dose gradually to a maximum of 5 mg per kilogram of body weight per day, as long as the medication is still well tolerated.

For nephrotic syndrome, the recommended starting dose is 3.5 mg per kilogram of body weight per day for adults and 4.2 mg per kilogram of body weight per day for children. People with reduced kidney function should not receive more than 2.5 mg per kg body weight per day as the starting dose. The total daily dose is usually increased to a maximum of 5 mg per kilogram in adults, or 6 mg per kilogram in children. Treatment should be stopped if no improvement is seen within 3 months of starting treatment.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

Swallow the capsules whole with some fluid. The oral solution should be diluted with a small amount of orange or apple juice, stirred, then swallowed immediately. Use a small amount of the juice to rinse the cup, stir, and swallow the contents again, to ensure the entire dose is taken.

It is important that Cyclosporine be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store cyclosporine capsules and solution at room temperature and protect from direct light. Keep the capsules in their original package until you are ready to take your dose. When the box of capsules is opened for the first time, there may be a distinct odour from the capsules. This is normal and does not mean the medication needs to be replaced.

Once the solution has been opened, it must be used within 2 months. It should not be stored below 20°C for a long period of time because a jelly-like formation may occur. If minor flakes or slight sediments are seen, the effectiveness and safety of the product and dosing will remain accurate.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause headaches; in rare cases it may cause your gums to become swollen or sensitive - see your dentist for your scheduled check-ups; it may cause unwanted hair growth; it may increase your blood pressure; rarely it may affect your kidneys, causing symptoms such as a decrease in urine volume and unusual tiredness - if you experience any of these symptoms, seek medical assistance immediately; it may cause shakiness. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

Apo-Cyclosporine is no longer being manufactured for sale in Canada. For brands that may still be available, search under cyclosporine. This article is being kept available for reference purposes only. If you are using Cyclosporine, speak with your doctor or pharmacist for information about your treatment options.

Do not take Cyclosporine if you:

• are allergic to cyclosporine or any ingredients of the medication
• are taking the medication Bosentan
• are taking Cyclosporine for psoriasis or rheumatoid arthritis and also have:
  • abnormal kidney function
  • any type of condition that negatively affects the function of the immune system
  • cancer (except non-melanoma Skin Cancer)
  • uncontrolled high blood pressure
  • uncontrolled infection

There may be an interaction between cyclosporine and any of the following:

• Acetazolamide
• Aliskiren
• Allopurinol
• aminoglycoside antibiotics (e.g., Amikacin, gentamicin, tobramycin)
• Amiodarone
• amphotericin B
• androgens (male hormones; methyltestosterone,testosterone)
• angiotensin converting enzyme inhibitors (ACEIs; e.g., Ramipril, Lisinopril)
• angiotensin receptor blockers (ARBs; e.g., candasartan, Irbesartan, Losartan)
• certain anti-psychotic medications (e.g., Aripiprazole, Haloperidol, Paliperidone, Risperidone)
• Aprepitant
• "azole" antifungals (e.g., itraconazole, ketoconazole, Voriconazole)
• barbiturates (e.g., butalbital, Phenobarbital, secobarbital)
• BCG
• biologic agents (e.g., Adalimumab, brentuximab, Infliximab, Natalizumab, Rituximab )
• birth control pills
• bosentan
• Bromocriptine
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• Carbamazepine
• Carvedilol
• caspofungin
• cetirizine
• chloroquine
• ciprofloxacin
• Cobicistat
• Colchicine
• Colesevelam
• conivaptan
• corticosteroids (e.g., budesonide, Dexamethasone, Hydrocortisone, fluticasone, Prednisone)
• dabigatran
• Danazol
• Deferasirox
• Digoxin
• diuretics (water pills; e.g., Furosemide, Hydrochlorothiazide, triamterene, Spironolactone)
• dofetilidedronedarone
• echinacea
• Enzalutamide
• Eplerenone
• estrogens (e.g., conjugated estrogen, Estradiol, ethinyl estradiol)
• Everolimus
• Ezetimibe
• Fenofibrate
• Gemfibrozil
• "gliptin" Diabetes medications (e.g., Linagliptin, Saxagliptin, Sitagliptin)
• grapefruit juice
• H2 antagonists (e.g., Cimetidine, Famotidine, Ranitidine)
• Hepatitis C antivirals (e.g., daclatasvir, dasabuvir, ledipasvir, paritaprevir, ombitasvir, simeprevir, sofosbuvir)
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• Hydrocodone
• hydroxychloroquine
• Leflunomide
• Lomitapide
• Loperamide
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• medications to treat cancer (e.g., Carboplatin, Cyclophosphamide, Doxorubicin, Ifosfamide, Vincristine)
• Mefloquine
• Metoclopramide
• Metronidazole
• mifepristone
• Modafinil
• multivitamins/minerals
• mycophenolate
• nefazodone
• non-steroidal anti-inflammatory medications (NSAIDs; e.g., Diclofenac, Ibuprofen, Naproxen)
• Norfloxacin
• Octreotide
• Omeprazole
• Ondansetron
• Orlistat
• Phenytoin
• Pimecrolimus
• Pimozide
• Primaquine
• primidone
• progestins (e.g., Dienogest, Levonorgestrel, medroxyprogesterone, Norethindrone)
• Propafenone
• Prucalopride
• pyrizinamide
• quinidine
• quinine
• Repaglinide
• rifabutin
• rifampin
• Rivaroxaban
• Roflumilast
• Romidepsin
• St. John's wort
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Paroxetine, Sertraline)
• Sirolimus
• Silodosin
• sulfonamide antibiotics ("sulfas"; e.g., sulfisoxazole, sulfamethoxazole)
• sulfonylureas (e.g., Gliclazide, Glyburide, Tolbutamide)
• "statin" anti-cholesterol medications (e.g., Atorvastatin, Lovastatin, Simvastatin)
• Tacrolimus
• terbinafine
• Ticagrelor
• Ticlopidine
• Tofacitinib
• Tolvaptan
• Trimethoprim
• tyrosine kinase inhibitors (e.g., Dasatinib, imatinib, Nilotinib, Sunitinib)
• vaccines
• vitamin C
• vitamin E

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Cyclosporine. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Cyclosporine.

Cancer: Cyclosporine reduces the number of cells that fight infection in the body (white blood cells). This may increase your risk of developing infections and cancer, especially those of the skin and lymphoid tissue.

People with psoriasis may be at increased risk of developing skin cancer as a result of previous psoriasis treatments. While you are taking cyclosporine, it is important to limit your exposure to the sun and use appropriate sun protection such as sunscreen and protective clothing. Your doctor will monitor you for skin cancer while you are taking Cyclosporine. Talk to your doctor if you have any concerns.

Dental health: It is particularly important to maintain good dental hygiene while taking Cyclosporine, and to see a dentist regularly for teeth cleaning.

High blood pressure: Cyclosporine may cause high blood pressure. Your doctor should monitor your blood pressure regularly while you are taking Cyclosporine.

High Cholesterol: Cyclosporine may increase cholesterol. Your doctor should monitor the amount of cholesterol in your blood regularly while you are taking cyclosporine.

Infection: Cyclosporine works by reducing the number of white blood cells in the body, making it easier to develop an infection. If possible, avoid contact with people who have contagious infections. Tell your doctor immediately if you notice signs of an infection, such as fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness. Your doctor will do blood tests regularly to monitor the number of specific types of blood cells in your blood.

Kidney function: Cyclosporine can have harmful effects on the kidney when it is taken for long periods of time. If you experience signs of decreased kidney function, such as reduced urine production; fluid build-up; or swelling in the ankles, feet and hands; fatigue; or abdominal pain, contact your doctor as soon as possible.

If you have reduced kidney function or Kidney Disease, discuss with your doctor how Cyclosporine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Cyclosporine, and whether any special monitoring is needed.

Liver function: People taking cyclosporine may have changes in liver function that produce abnormal liver test results. Liver disease or reduced liver function may cause Cyclosporine to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how Cyclosporine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Cyclosporine, and whether any special monitoring is needed.

Your doctor will likely recommend regular liver tests while you are taking Cyclosporine. If you have severe changes in liver function, your doctor may recommend that you take a lower dose of Cyclosporine or stop taking it altogether.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Potassium levels: Cyclosporine increases the risk of high levels of potassium in your body, especially for people who have decreased kidney function. Your doctor will monitor the amount of potassium in your blood with blood tests. If you experience unexplained nausea, fatigue, muscle weakness or tingling sensations, contact your doctor, as these may be signs of too much potassium.

Progressive Multifocal leukoencephalopathy (PML): There have been reports of PML after using cyclosporine. PML is a rare disorder that causes nerve damage in the brain. If you experience memory loss, vision changes, trouble thinking, seizures, sleeplessness, disorientation, personality changes or difficulty walking, contact your doctor immediately.

Vaccines: People taking cyclosporine may not respond as well to vaccines or may be at risk of becoming ill from a live vaccine. Talk to your doctor if you need any vaccinations while taking Cyclosporine.

Pregnancy: Cyclosporine should be used during pregnancy only if the benefits outweigh the risks. If you become pregnant while taking Cyclosporine, contact your doctor immediately. Do not stop taking Cyclosporine without guidance from your doctor.

Breast-feeding: Cyclosporine passes into breast milk. If you are a breast-feeding mother and are taking cyclosporine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: Many studies have shown that children require higher doses per kilogram of body weight than adults. It is not recommended for children for the treatment of psoriasis or rheumatoid arthritis.

This medication is typically used twice a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. Important: Follow the instructions on the label. Do not use more of this product, or more often, than prescribed. The capsule of this medication should not be opened, crushed or chewed. It must be used regularly and continuously to maintain its beneficial effects. Be sure to keep an adequate supply on hand. You should take this medication at approximately the same time each day. This medication may be taken with or without food. Avoid grapefruit and grapefruit juice during your treatment. Grapefruit can seriously affect how this medication works.