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cyclosporine (cyclosporin A)
Neoral, Sandimmun‡, Sandimmune

Pregnancy Risk Category C

How supplied
Oral solution:
100 mg/ml
Capsules:
25 mg, 50 mg, 100 mg
Capsules for microemulsion:
25 mg, 50 mg
Injection:
50 mg/ml

Action
Unknown. Thought to inhibit proliferation and function of T lymphocytes and inhibit production and release of lymphokines.

Indications & dosage
Prophylaxis of organ rejection in kidney, liver, or heart transplantation--

Adults and children:
15 mg/kg P.O. 4 to 12 hours before transplantation and continued daily postoperatively for 1 to 2 weeks. Then dose reduced by 5% each week to maintenance level of 5 to 10 mg/
kg/day. Or, 5 to 6 mg/kg I.V. concentrate 4 to 12 hours before transplantation given as a continuous infusion. Postoperatively, dose repeated daily until patient can tolerate P.O. forms.
Elderly:
dosage adjustment may be
needed.
Severe, active rheumatoid arthritis that hasn't adequately responded to methotrexate (Neoral only)--

Adults:
2.5 mg/kg/day P.O., taken b.i.d. as divided dose.
Adjust-a-dose:
For patients with such adverse effects as hypertension, elevations in serum creatinine level (30% above pretreatment level), or abnormal CBC and liver function test results, decrease dosage by 25% to 50%.

Adverse reactions
CNS:
tremor, headache, confusion, paresthesia.
CV:
hypertension.
EENT:
gum hyperplasia, oral thrush,
sinusitis.
GI:
nausea, vomiting, diarrhea, abdominal discomfort.
GU:
NEPHROTOXICITY, gynecomastia.
Hematologic:
anemia, leukopenia, thrombocytopenia.
Hepatic:
hepatotoxicity.
Metabolic:
hyperglycemia.
Skin:
hirsutism, acne, flushing.
Other:
increased low-density lipoprotein levels, infections, anaphylaxis.

Interactions
Drug-drug.
Acyclovir, aminoglycosides, amphotericin B, co-trimoxazole, melphalan, NSAIDs, ranitidine, vancomycin: increased risk of nephrotoxicity. Avoid concomitant use.
Azathioprine, corticosteroids, cyclophosphamide, verapamil:
increased immunosuppression. Monitor closely.
Carbamazepine, isoniazid, phenobarbital, phenytoin, rifabutin, rifampin:
possible decreased immunosuppressant effect secondary to low cyclosporine levels. Cyclosporine dosage may need to be increased.
Cimetidine, danazol, diltiazem, erythromycin, fluconazole, imipenem-cilastatin, ketoconazole, methylprednisolone, metoclopramide, nicardipine, prednisolone:
may increase blood levels of cyclosporine. Check for increased toxicity.
Digoxin:
cyclosporine may elevate digoxin levels. Monitor patient for toxicity.
Potassium-sparing diuretics:
cyclosporine may induce hyperkalemia. Monitor patient closely.
Vaccines:
decreased immune response. Postpone routine immunization.
Drug-food.
Grapefruit juice: slowed metabolism of drug. Avoid concomitant use.
High-fat meals:
Neoral absorption may be decreased by a high-fat meal. Give on empty stomach.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with hypersensitivity to drug or polyoxyethylated castor oil (found in injectable form). Patients who have rheumatoid arthritis and hypertension, malignancies, or impaired renal function shouldn't receive Neoral.

Nursing considerations

I.V. administration

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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