Sandimmune

Generic Name

cyclosporine (si kloh SPOR een)

 

Trade Name

Neoral
Sandimmune

 

What is cyclosporine?

Cyclosporine is used to suppress the immune system so as to prevent the rejection of transplanted organs. It is the immune system which would otherwise damage the transplanted organ. In gastroenterology, certain disorders such as ulcerative colitis, Crohn’s disease and autoimmune hepatitis, are felt to be related to an overactive immune system. In some circumstances the physician may recommend treatment.

 

What is it used for?

Cyclosporine has been found to be effective in the acute phase of ulcerative colitis when given intravenously. When given by mouth in the chronic phase of this disorder and with Crohn’s disease, its beneficial effect is less certain. Its main use is in transplant patients.

 

How do I take it?

Follow your physician’s instructions carefully. Cyclosporine should be taken at the same time each day to maintain a steady blood level. It may be taken on an empty stomach or with food to reduce stomach irritation. The capsules should be swallowed whole and not opened, crushed or chewed. Sandimmune liquid may be mixed with room temperature milk, chocolate milk or orange juice. Neoral liquid may be mixed with room temperature orange or pineapple juice. Do not mix either with grapefruit juice. Stir well and drink at once. Use a glass container. To make sure you get the full dose, rinse the glass with more liquid and drink that too. There may be an odor when you open the capsule container. This is of no consequence. Store both capsule and liquids in a tightly sealed container below 86 degrees Fahrenheit. Do not store the liquid in the refrigerator and keep it from freezing. Sandimmune liquid, once opened, must be used within two months. Keep all medications away from children. Never share your medications with anyone else.

 

What do I do for a missed dose?

If less than 12 hours have passed, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and return to your regular schedule. Do not double up on this medication.

 

Are there interactions with food or beverages?

Avoid excessive intake of high potassium foods. Do not take the liquid form of this medication with grapefruit juice because it can increase blood levels of the drug.

 

Are there interactions with other drugs?

An interaction generally means that one drug may increase or decrease the effect of another drug. Also, the more medications a person takes, the more likely there will be a drug interaction.

Interactions with this drug may occur with the following:

  • diuretics (Aldactone, Dyazide)
  • anti-convulsant (Dilantin, carbamazepine, phenobarbital)
  • antibiotics (erythromycin, Bactrim, Biaxin)
  • anti-fungals (Diflucan, Sporanox, Nizoral, Monistat)
  • birth control pills
  • cortisone
  • cyclophosphamide (Cytoxan)
  • azathioprine (Imuran)
  • calcium channel blockers ( Cardizem, Calan)
  • arthritis drugs (ibuprofen, Advil, Motrin, many others)
  • tuberculosis medication

 

Is there a problem if I have another disorder or disease?

At times, a drug may have a different or enhanced effect when other diseases are present. At other times, the drug may worsen or effect another disease.

With this drug, the following disorders may be a problem:

  • chronic kidney disease
  • chronic liver disease
  • hypertension (high blood pressure)
  • anemia
  • history of low white or red blood cell count
  • bone marrow problems

 

What about allergies?

People who have known allergies or asthma may be at an increased risk for a reaction from any new medication. The physician should always know a patient’s allergy history. Signs of an allergic reaction are skin rash, hives and itching. Of course, a person should not take cyclosporine if there has been a previous reaction to this or castor oil.

 

What if I’m pregnant, considering pregnancy or breast-feeding?

Most females now know that, if possible, no drug, including alcohol, should be taken during pregnancy or lactation. The potential danger, of course, is an injury to the baby. However, some drugs are much safer than others in this regard. So, the FDA has a grading system for each drug which reflects what is known medically. It ranks drugs from A, where medical studies show no evidence for danger to the fetus or mother, to B, C, D and X, where the medical evidence indicates that the risk to the fetus outweighs any benefit to the mother. Cyclosporine is ranked C. Always consult your physician before taking any drug during or when planning pregnancy.

 

What are the effects on sexual function?

Cyclosporine can cause enlargement or tenderness of the breasts in males.

 

Are there other precautions?

You should maintain good dental hygiene and see your dentist frequently for cleaning to prevent gum tenderness, bleeding or swelling. When your immune system is suppressed, you are at an increased risk of infection, so report promptly to your physician any indication of infection such as fever, sore throat, swollen glands, sores or lumps in the skin, abnormal bleeding or bruising. Avoid immunizations while taking this drug and avoid contact with individuals who have recently taken oral poliovirus vaccine. Also inform your physician if you have had a recent infection, especially chicken pox or shingles.

 

How long is it safe to take cyclosporine?

This drug can be taken long-term. Because of erratic intestinal absorption, constant monitoring of blood levels and dose adjustments are necessary to avoid over or under dosing. The newer drug, Neoral, seems to provide more even blood levels.

 

How about side effects?

Adverse reactions can occur with any drug, even over-the-counter medications. Some of these are mild such as a stomach upset, which may be avoided by taking the medication with food. Minor reactions may go away on their own but if they persist, contact the physician. For major reactions, the patient should contact the physician immediately.

For cyclosporine, the following are the observed side effects:

Minor:

  • headache
  • loss of appetite
  • tremors
  • swollen gums
  • leg cramps
  • acne
  • increased hair growth

Major:

  • fever
  • sore throat
  • urgent or painful urination
  • blood in urine
  • severe stomach pain
  • nausea
  • vomiting
  • hypertension

 

A physician’s comment…

In gastroenterology, this drug is needed in liver transplantation. It is also useful in the acute phase of ulcerative colitis when given intravenously. The results when given by mouth over the long-term for Crohn’s disease and ulcerative colitis have not been that good. Since there are a number of side effects such as high blood pressure and abnormal blood count and kidney function, physicians generally use it only when other simpler drugs have been ineffective