Cyclosporine (Neoral®, Sandimmune®, Restasis®, Gengraf®)
Classification: Immunosuppressant Agent
About Cyclosporine (Neoral®, Sandimmune®, Restasis®, Gengraf®)
Cyclosporine is a type of medication called an immunosuppressant and works primarily by inhibiting T lymphocytes. T lymphocytes are a type of white blood cell that is an important component of immune function.
How to Take Cyclosporine
Cyclosporine comes in a capsule or liquid formulation to be taken by mouth, or an intravenous (IV) version. There are two types of oral cyclosporine, the original version (Sandimmune®) and a version that is more rapidly available in your system (Neoral® and Gengraf®, also called modified cyclosporine). Because the body absorbs these two types of the medication differently, they are not interchangeable and you must be sure you receive the type your doctor prescribes. In addition, there are a few rules to follow when taking either type of cyclosporine:
- Do not drink grapefruit juice while on this medication, as it interferes with the body's absorption of the medication.
- Levels of the medication in your blood can vary and, for this reason, will be monitored with periodic blood tests.
- The liquid form can be mixed in milk (regular or chocolate), orange or apple juice, and should be added to a glass (not a plastic container) containing the liquid. The mixture should be drunk right away and the glass filled with the liquid a second time and drunk to rinse any medication remaining in the glass.
- Do not store in the refrigerator.
Restasis® is an eye drop formulation of cyclosporine that is used to treat chronic dry eyes resulting from ocular inflammation.
Many other medications, vitamins and herbs can interfere with cyclosporine levels in the blood. Be sure to let your healthcare team know about all medications or supplements you are taking.
Storage and Handling
Store this medication at room temperature in the original container. If you prefer to use a pillbox, discuss this with your oncology pharmacist. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.
Where do I get this medication?
Cyclosporine is typically available through retail/mail order pharmacy. Your oncology team will work with your prescription drug plan to identify an in-network retail/mail order pharmacy for medication distribution.
This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals without prescription drug coverage. Co-pay assistance, which reduces the patient co-pay responsibility for eligible, commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources, if they are available.
This medication is covered under Medicare part B for Medicare recipients. If you have Medicare, make sure your pharmacist knows to process this prescription through your Medicare part B and NOT part D.
Possible Side Effects
There are a number of things you can do to manage the side effects of cyclosporine. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
High Blood Pressure
This medication can cause high blood pressure (hypertension). Patients should have their blood pressure checked regularly during therapy. Any hypertension should be treated appropriately. If hypertension cannot be controlled, the medication may be stopped. Report any headache or dizziness to your provider.
Tremors in the hands are common with cyclosporine, particularly when starting therapy or increasing the dose. These tend to decrease over time as your body adjusts to the medication.
Cyclosporine can cause a decrease in kidney function or damage to the kidney. For this reason, your healthcare team will monitor your kidney function with blood tests while taking cyclosporine. Some patients will need to stop the medication due to kidney function changes. Notify your provider if you notice any decrease in urination or darkening or the urine.
Nausea and/or Vomiting
Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
This medication may cause headaches or migraines. Headache can also be a sign of elevated blood pressure, so this side effect should be reported to your provider for further evaluation.
Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration.
You, and individuals who you live with, should not receive vaccines that contain live virus, including oral polio, measles, or the nasal flu vaccine (FluMist) while you are receiving this medication. Vaccines may not work as well as they should while taking this medication. Discuss this with your provider before receiving any vaccines.
Posterior Reversible Encephalopathy Syndrome (PRES)
In rare cases this medication has caused a neurological disorder called posterior reversible encephalopathy syndrome (PRES). Symptoms of PRES include headache, seizure, lethargy, confusion, blindness and other visual and neurological disturbances. Report any of these symptoms to your healthcare team immediately.
Exposure of an unborn child to this medication could cause birth defects, this medication should only be used during pregnancy when the benefits outweigh the risk. You should discuss this with your healthcare team before becoming pregnant. Effective birth control is necessary during treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.