Cyclosporine

Cyclosporine, also called ciclosporin, is a drug used for various purposes. These purposes include the most popular, aiding the human body in the process of accepting a new organ via an organ transplantation surgery; to treat asthma, arthritis, psoriasis, ulcerative colitis and eye irritations. Additionally, cyclosporine in the form of Atopica, which is essentially a form of cyclosporine, is used to treat atopic dermatitis in dogs and cats. Generally, this drug is prescribed and sold under the brand names, Gengraf, Neoral, Restasis and Cicloral.

Understanding Cyclosporine

In the most popular use of the drug; when it is applied to the human body, it works by preventing lymphokine cells from producing which results in a reduction in T-cell function. Now what is the importance of this? Well, the T-cells will not be able to actively fight a transplant, such as an organ which it might read as a threat to the organism, that is, the body. As such, with no objection, the organ will begin to function properly within the body.

Ideally it is important to note that not in all instances will the body reject an organ; however cyclosporine is still used as a precautionary method in case the T-cells start fighting the new organ. This is also seen with some skin conditions or even with ulcerative colitis where cyclosporine will prevent the body from trying to reject whatever it may feel is a threat to its health and overall function.

 Things to Avoid While Taking Cyclosporine

Now, there are precautionary measures to be taken whilst taking cyclosporine. Grapefruit juice as well as the fruit itself should be avoided at all costs, that is, it should not be consumed. Why you may ask? Well the contents of this fruit have interactive effects with cyclosporine that will affect its purpose and has the ability of causing grave effects. This is why doctors who prescribe it will reiterate the importance of staying away from it.

Cyclosporine Side Effects

Additionally, you should contact your doctor who prescribed cyclosporine to you as soon as you start to experience difficulty breathing, severe vomiting, kidney pains, dizziness, seizures, headaches or any other side effect that is abnormal to you. Moreover, it is never advisable to take cyclosporine without it being prescribed to a doctor and be sure to consult your doctor before decreasing cyclosporine’s dosage intake or when you decide to stop taking it all-together.

Now how is cyclosporine usually used? Cyclosporine is usually given in gel form via a capsule from your doctor. It is also available in a liquid emulsion form. If you are taking the gel capsule, do so with a glass of water. If you are taking the liquefied emulsion form, mix it with juice (such as apple juice) or milk, but never grapefruit juice!

Lastly, doctors usually prescribe cyclosporine in different dosages depending on its usage. If it is to be used to prevent a transplant rejection, it will be prescribed in high dosages but if it is for conditions such as arthritis, the dosages will be low!

What is Cyclosporine ?

Cyclosporine (brand names Sandimmune®, Gengraf® and Neoral®) is a medication that suppresses the immune system. It comes in an original form and one that has been modified to make it easier for the body to absorb. It works by inhibiting the T-lymphocytes in the immune system.

Why is it prescribed?

Cyclosporine is prescribed to prevent organ transplant rejection, particularly of the liver, kidney and heart. Less frequently, it is used to prevent rejection of other types of transplants, including bone marrow, pancreas, lungs, and corneas.

In addition, it is used to treat autoimmune diseases, e.g. rheumatoid arthritis, lupus and severe cases of psoriasis. The drug not only reduces pain and swelling associated with these diseases, but may actually prevent further damage to the joints and reduce the risk of the resultant long-term disability. Cyclosporine is also sometimes used to treat Crohn’s disease, which is an autoimmune disease that affects the colon and digestive tract.

What is the dosage?

Cyclosporine is available in both a capsule and liquid form, taken by mouth. Dosage varies depending on whether the patient is using the original or modified formula of the drug. The two types should not be used interchangeably. The drug is also available in an intravenous form. The original form of cyclosporine is usually taken once a day; the modified form is taken twice daily. Either form should be taken on a regular schedule to maintain a constant level in the blood.

If being taken to prevent transplant rejection, your doctor will probably prescribe a higher dose to begin with and then taper it off. For autoimmune diseases, the dosage would start off lower, and be gradually increased, depending on your response.

The capsules are available in dosages of 25 mg. and 100 mg. The usual starting dose is 2.5 mg. per kilogram of body weight, and the usual daily dose is ultimately about 75 mg. to 100 mg. taken twice daily (modified formula), again depending on the condition being treated. For treatment of arthritis, the effects may not be felt for at least a week, and often it will take up to three months before the full effect is realized.

The liquid form of cyclosporine should be mixed with juice or some other type of beverage. The modified form should not be mixed with milk; however, milk or chocolate milk are acceptable for the original formula. Neither should be mixed with grapefruit juice. In addition, avoid eating any grapefruit and limit potassium-rich foods, e.g. bananas, prunes, raisins, orange juice, etc.

Contraindications

Since cyclosporine suppresses the immune system, patients who take it have a higher risk of infections and certain types of cancer, e.g. lymphoma or skin cancer. In addition, the drug can cause high blood pressure and kidney damage. Do not take cyclosporine if you are pregnant or are intending to become pregnant, as it can cause serious complications, e.g. pre-eclampsia and pre-term labor. Do not take cyclosporine while nursing. Do not receive a live vaccine while taking cyclosporine; make sure your vaccinations are up to date before starting treatment.

Do not use Cyclosporine if you have previously had an allergic reaction to it. Also be sure to let your doctor know of any other allergies you may have.

You should also talk to your physician about any vitamins or herbal supplements you may be taking (especially St. Johns Wort) and let him or her know if you have had any of the following:

• Kidney disease
• High blood pressure
• Low cholesterol
• Low magnesium levels
• Liver problems
• Thrombocytopenic purpura (blood clotting problem)
• Cancer
• Previous treatment for psoriasis

Interactions

Cyclosporine may interact with the following drugs. Please let your physician know if you are taking any of these drugs before starting Cyclosporine.

• Azathiopine (Imuran®)
• Sirolimus (Rapamune®)
• Tacrolimus (Prograf®)
• Amphotericin B (Fungizone®, Amphotec®)
• Cimetadine (Tagamet®)
• Rantadine (Zantac®)
• Ciprofloxacin (Cipro®)
• Colchicine
• Fenofibrate (Antara®, Tricor®, etc.)
• Gemfibrozil (Lopid®)
• Methotrexate (Rhematrex®, Trexall®)
• Non-steroidal anti-inflammatory medications, e.g. naproxen (Aleve®, Naprosyn®), diclophenac (Voltaren®), sulindac (Clinoril®), etc.
• Medications to treat ulcerative colitis, e.g. sulfasalazine (Azulfidine®)
• Certain antibiotics, including vancomycin, bacitracin, gentamicin and others
• Ketoconazole (Nizoral®)
• Melphalan (Alkeran®)
• Acyclovir (Zovirax®)
• Amiodarone (Cordarone®)
• Allopurinol (Zyloprim®);
• Certain blood pressure medications called  ACE inhibitors, e.g. enalapril (Vasotec®, benazepril (Lotensin®), captopril (Capoten®), and others
• Blood pressure medications called ARBs, e.g. valsartan (Diovan®), olmesartan (Benicar®), candesartan (Atacand®), etc.
• Calcium channel blockers, including diltiazem (Cardizem®) and verapamil (Calan®)
• Atifungal medications; for example, itraconazole (Sporanox® and fluconazole (Diflucan®)
• Azithromycin (Zithromax®
• Bromocriptine (Parlodel®)
• Carbamazepine (Tegretol®)
• Statins (drugs to lower cholesterol), e.g. atorvastatin (Lipitor®), lovastatin (Mevacor®), simvastatin (Zocor®), etc.
• Clarithromycin (Biaxin®)
• Digoxin (Lanoxin®)
• Phenobarbital
• Phenytoin (Dilantin®)
• Prednisolone (Pediapred®)
• Diuretics, including amiloride (Midamor®) and spironolactone (AldactoneErythromycin
• HIV medications, e.g. indinavir (Crixivan®) and nelfinavir (ViraceptImatinib (Gleevec®)
• Metoclopramide (Reglan®)
• methylprednisolone (Medrol®)
• Nafcillin
• Oral contraceptives
• Orlistat (Xenical®)
• Repaglinide (Prandin®)
• Rifabutin (Mycobutin®)
• Rifampin (Rifadin®)
• Sulfinpyrazone (Anturane®)
• Terbinafine (Lamisil®)
• Ticlopidine (Ticlid®).

This may not be a complete list; be sure your doctor is aware of all medications you are taking.

Side Effects

The following side effects are most common with this drug. Call your doctor if they become acute or persistent.

• Flushing
• Acne
• Diarrhea
• Gas/heartburn
• Growth of extra tissue on your gums
• Increased hair growth on body
• Shaking of your hands or other body parts
• Cramps
• Paresthesia (tingling in hands, feet or other locations)
• Headache
• Insomnia
• Ear problems
• A feeling of pressure on the face
• Joint or muscle pain
• Depression
• Breast engorgement in men

Call your doctor right away if you have any of the following serious side effects.

• Symptoms of allergic reaction , e.g. swelling of the tongue, throat, lips or face; rash or hives, itching, trouble breathing.
• Purple blotches on skin
• Rash
• Unusual bruising or bleeding
• Jaundice (yellow color to eyes or skin)
• Seizures
• Change in behavior or mood
• Unconsciousness
• Vision changes
• Confusion
• Loss of control of body movements
• Pallor
• Edema of hands or feet (swelling)
• Chest pain
• Dark urine
• Nausea/vomiting
• Change in amount or color of the urine
• Sore throat
• Symptoms of the flu
• Change in appearance of moles
• Swollen glands
• Unusual lumps
• Night sweats
• Vomiting blood or material like coffee grounds
• Abdominal pain

Avoid the sun and wear sunscreen when taking cyclosporine to reduce the risk of skin cancer. If you have any concerning symptoms that may be a result of taking this medication, do not hesitate to contact your physician.

References:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000155/

http://www.webmd.com/drugs/mono-9108-CYCLOSPORINE+CAPSULE+-+ORAL.aspx?drugid=5645&drugname=Cyclosporine+Oral&source=0

http://www.rheumatology.org/practice/clinical/patients/medications/cyclosporine.asp

This site will be up and running soon with information on Cyclosporine