What is cyclosporine (systemic)?


Generic Name: Cyclosporine (Systemic) Brand Name(s): Generics only. No brands available.

Know the basics

What is cyclosporine (systemic) used for?

Cyclosporine is used to prevent organ rejection in people who have received a liver, kidney, or heart transplant. It is usually taken along with other medications to allow your new organ to function normally. Cyclosporine is also used to treat severe rheumatoid arthritis and a certain skin condition (severe psoriasis). Cyclosporine belongs to a class of drugs known as immunosuppressants. It works by slowing down your body’s defense system (immune system) to prevent your body from rejecting a transplanted organ, further damaging your joints (in rheumatoid arthritis patients), or further damaging your skin (in psoriasis patients). For the treatment of psoriasis or arthritis, it is generally used to treat people who cannot take other medications or have not found relief from other treatments.

Cyclosporine may also be used to prevent rejection in other types of organ transplants (e.g., corneapancreas) or bone marrow transplant. It may also be used to treat other conditions that may be helped by affecting the immune system (e.g., Crohn’s disease).

How should I take cyclosporine (systemic)?

Cyclosporine is available as injectable and oral form.

Cyclosporine is given into a vein as directed by your doctor, usually once daily over 2 to 6 hours. If you are giving cyclosporine to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.

When cyclosporine is given into a vein, one of the other ingredients in this product, polyoxyethylated castor oil, may rarely cause a serious allergic reaction. If you are using cyclosporine at home, be prepared to self-treat as directed by your doctor if symptoms of an allergic reaction occur.

With oral form, take cyclosporine by mouth, usually once daily at the same time each day, or take as directed by your doctor. You may take it with or without food, but it is important to choose one way and take every dose that way. Dosage is based on your medical condition, cyclosporine blood level, kidney function, and response to therapy. Follow the dosing schedule for this medication carefully.

To improve the taste of this liquid medication, mix it with milk, chocolate milk, or orange juice. Using the dosing syringe, measure your dose into a cup of milk or orange juice, stir well, and drink as soon as possible. It is best to use a glass cup whenever possible. Do not use plastic foam cups. To make sure that all the medication is taken, add more juice to the cup, stir, and drink, then repeat.

Use cyclosporine regularly in order to get the most benefit from it. Remember to use it at the same time each day.

Cyclosporine works best when the amount of medicine in your body is kept at a constant level. Therefore, take this drug at evenly spaced intervals.

If you are taking cyclosporine to treat arthritis, it may take 4-8 weeks to notice improvement, and up to 4 months for the full benefit.

If you are taking cyclosporine to treat psoriasis, it may take 2-4 weeks to notice improvement, and up to 4 months for the full benefit. Your dose will slowly be increased during your therapy with this drug. Inform your doctor if your condition does not improve after 6 weeks of taking the highest recommended dose. If you are taking cyclosporine to treat psoriasis, do not take it continuously for longer than one year unless directed to do so by your doctor.

How do I store cyclosporine (systemic)?

Cyclosporine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store cyclosporine in the bathroom or the freezer. There may be different brands of cyclosporine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush cyclosporine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Know the precautions & warnings

What should I know before using cyclosporine (systemic)?

Before taking cyclosporine,

  • tell your doctor and pharmacist if you are allergic to cyclosporine, cyclosporine (modified), any other medications, or any of the inactive ingredients in cyclosporine or cyclosporine (modified) capsules or solution. Ask your pharmacist for a list of the inactive ingredients.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking, or plan to take. Be sure to mention any of the following: acyclovir (Zovirax); allopurinol (Zyloprim); amiodarone (Cordarone); angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik); angiotensin II receptor antagonists such as candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan); certain antifungal medications such as fluconazole (Diflucan), and itraconazole (Sporanox); azithromycin (Zithromax); bromocriptine (Parlodel); calcium channel blockers such as diltiazem (Cardizem), nicardipine (Cardene), and verapamil (Calan); carbamazepine (Tegretol); cholesterol-lowering medications (statins) such as atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), and simvastatin (Zocor); clarithromycin (Biaxin); dalfopristin and quinupristin combination (Synercid); danazol; digoxin (Lanoxin); certain diuretics (‘water pills’) including amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyazide); erythromycin; HIV protease inhibitors such as indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra), and saquinavir (Fortovase); imatinib (Gleevec); metoclopramide (Reglan); methylprednisolone (Medrol); nafcillin; octreotide (Sandostatin); oral contraceptives (birth control pills); orlistat (Xenical); phenobarbital; phenytoin (Dilantin); potassium supplements; prednisolone (Pediapred); repaglinide (Prandin); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane); sulfinpyrazone (Anturane); terbinafine (Lamisil); and ticlopidine (Ticlid). Your doctor may need to change the doses of your medications or monitor you more carefully for side effects.
  • if you are taking sirolimus (Rapamune), take it 4 hours after you take cyclosporine or cyclosporine (modified).
  • tell your doctor what herbal products you are taking, especially St. John’s wort.
  • tell your doctor if you have or have ever had any of the following conditions: low cholesterol, low levels of magnesium in your blood, any condition that makes it difficult for your body to absorb nutrients, or liver disease.
  • tell your doctor if you are pregnant or plan to become pregnant. If you become pregnant while taking either type of cyclosporine, call your doctor. Both types of cyclosporine may increase the risk that your baby will be born too early.
  • tell your doctor if you are breast-feeding or planning to breast-feed.
  • do not have vaccinations without talking to your doctor.
  • you should know that cyclosporine may cause growth of extra tissue in your gums. Be sure to brush your teeth carefully and see a dentist regularly during your treatment to decrease the risk that you will develop this side effect.

Is it safe to take cyclosporine (systemic) during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this medication during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking this medication. This medication is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Know the side effects

What are the side effects of cyclosporine (systemic)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

  • fever, sweating, chills, body aches, flu symptoms, sores in your mouth and throat, weight loss;
  • change in your mental state, problems with speech or walking, decreased vision (may start gradually and get worse quickly);
  • easy bruising or bleeding, pale skin, confusion or weakness;
  • feeling light-headed or short of breath, rapid heart rate, trouble concentrating;
  • pain in the lower back or side, blood in your urine, pain or burning when you urinate;
  • urinating less than usual or not at all, rapid weight gain;
  • swelling, warmth, redness, or oozing of the skin;
  • vomiting and bloody diarrhea;
  • seizure (convulsions);
  • high potassium (slow heart rate, weak pulse, muscle weakness, tingly feeling);
  • nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or
  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, chest pain, shortness of breath, uneven heartbeats).

Less serious side effects may include:

  • swollen or painful gums;
  • mild headache;
  • stomach pain, constipation, mild diarrhea; or
  • tremors or shaking, muscle spasm, numbness or tingly feeling.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Know the interactions

What drugs may interact with cyclosporine (systemic)?

Cyclosporine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Some products that may interact with this drug include: birth control pills, caspofungin, coal tar, ezetimibe, sulfinpyrazone, tacrolimus, temsirolimus, terbinafine, other drugs that weaken the immune system/increase the risk of infection (such as natalizumab, rituximab, tofacitinib), drugs that worsen kidney problems (e.g., acyclovir, aminoglycoside antibiotics including tobramycin; amphotericin B; colchicine; melphalan; ranitidine; sulfa drugs including sulfamethoxazole; vancomycin), drugs that may increase potassium levels (e.g., potassium supplements, “water pills” including amiloride, spironolactone).

Other medications can affect the removal of cyclosporine from your body, which may affect how cyclosporine works. Examples include allopurinol, amiodarone, barbiturates including phenobarbital, boceprevir, bosentan, calcium channel blockers including diltiazem/nifedipine/verapamil, cimetidine, HIV protease inhibitors including indinavir, imatinib, certain man-made male hormones such as danazol/methyltestosterone, methylprednisolone, metoclopramide, metronidazole, mifepristone, nafcillin, nefazodone, octreotide, orlistat, quinupristin/dalfopristin, rifamycins including rifampin/rifabutin, certain anti-seizure drugs including carbamazepine/phenytoin, St. John’s wort, telaprevir, ticlopidine, among others.

This medication can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include aliskiren, ambrisentan, digoxin, dronedarone, repaglinide, tolterodine, statins (such as atorvastatin, lovastatin, pitavastatin, rosuvastatin, simvastatin), other immunosuppressants (such as azathioprine, methotrexate, sirolimus), among others.

Do not use potassium-containing salt substitutes while taking this medication. Consult your doctor or pharmacist for more information.

Does food or alcohol interact with cyclosporine (systemic)?

Cyclosporine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

  • Grapefruit or grapefruit juice.

What health conditions may interact with cyclosporine (systemic)?

Cyclosporine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have, especially:

  • Allergy to polyoxyethylated castor oil (Cremophor® EL)—Should not be used in patients with this condition.
  • Anemia;
  • Bleeding problems;
  • Brain disease (e.g., encephalopathy);
  • Cancer;
  • Eye or visual problems (e.g., papilloedema);
  • Hyperkalemia (high potassium in the blood);
  • Hypertension (high blood pressure);
  • Hyperuricemia (too much uric acid in the blood);
  • Kidney disease;
  • Liver disease;
  • Precancerous skin changes;
  • Seizures, history of;
  • Thrombocytopenia (low number of platelets)—Use with caution. May make these conditions worse.
  • Hypertension (high blood pressure);
  • Hypocholesterolemia (low cholesterol in the blood);
  • Hypomagnesemia (low magnesium in the blood)—May increase risk for encephalopathy.
  • Infection—May decrease body’s ability to fight infection.

Understand the Dosage

The information provided is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist before using this medication.

What is the dose of Cyclosporine for an adult?

Usual Adult Dose for Organ Transplant – Rejection Prophylaxis

2 to 4 mg/kg/day intravenous infusion once a day over 4 to 6 hours or
1 to 2 mg/kg intravenous infusion twice a day over 4 to 6 hours or
2 to 4 mg/kg/day as a continuous intravenous infusion over 24 hours.
Capsules: 8 to 12 mg/kg/day orally in 2 divided doses.
Solution: 8 to 12 mg/kg orally once a day.

Usual Adult Dose for Rheumatoid Arthritis

Cyclosporine formulation for emulsion: 5 mg/kg/day orally divided in 2 doses. If possible, anti-inflammatory drugs should be discontinued to help avoid renal toxicity. A maximum dose of 5 mg/kg/day and a maximal increase in serum creatinine levels no more than 30% above baseline values are recommended to minimize renal toxic effects.

Cyclosporine capsules – Initial dose: 1.25 mg/kg orally twice a day.

Usual Adult Dose for Ulcerative Colitis – Active

When refractory to corticosteroids: 4 mg/kg/day via continuous intravenous infusion.

Usual Adult Dose for Psoriasis

Refractory plaque-type psoriasis: cyclosporine formulation for emulsion: 2.5 mg/kg/day orally in 2 equally divided doses.

Cyclosporine capsules – Initial dose: 1.25 mg/kg twice a day.

What is the dose of Cyclosporine for a child?

Usual Pediatric Dose for Organ Transplant – Rejection Prophylaxis

IV: 2 to 4 mg/kg/day intravenous infusion once a day over 4 to 6 hours or
1 to 2 mg/kg intravenous infusion twice a day over 4 to 6 hours or
2 to 4 mg/kg/day as a continuous intravenous infusion over 24 hours.
Capsules: 8 to 12 mg/kg/day orally in 2 divided doses.
Solution: 8 to 12 mg/kg orally once a day.

How is cyclosporine available?

Cyclosporine is available in the following dosage forms and strengths:

Solution, Oral: 100 mg/mL.

Capsule, Oral: 25 mg, 100 mg.

Intravenous Infusion: 50 mg/mL.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

Symptoms of overdose may include:

  • yellowing of the skin or eyes
  • swelling of the arms, hands, feet, ankles, or lower legs.

What should I do if I miss a dose?

If you miss a dose of cyclosporine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

msBahasa Malaysia

Review Date: May 30, 2016 | Last Modified: January 4, 2017

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