Cyclosporine, Oral Capsule

Medically reviewed by University of Illinois-Chicago, Drug Information Group on November 16, 2016Written by University of Illinois-Chicago, Drug Information Group

Important warnings

FDA warnings

  • This drug has black box warnings. A black box warning is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
  • Infection warning. Cyclosporine may increase your risk of serious infections. It may also increase your risk of developing a tumor or skin cancer.
  • Skin disease warning. If you have psoriasis and have been treated with either psoralen plus ultraviolet A therapy, methotrexate, coal tar, radiation therapy, or ultraviolet light therapy, you may have a higher chance of developing a skin disease while taking cyclosporine capsules.
  • High blood pressure and kidney disease warning. This medication may cause high blood pressure and kidney disease.

Other warnings

  • Liver damage warning: Taking cyclosporine may cause liver damage and liver failure, especially if you take high doses. It may even be fatal.
  • High potassium levels warning: Taking this drug may raise your potassium levels.
  • Risk of infection warning: Cyclosporine weakens the immune system. If you take this medication, you may be at greater risk for infections from bacteria, fungus, and viruses. These infections may be serious or life-threatening.

What is cyclosporine?

Cyclosporine is a prescription drug. It comes as an oral capsule, an oral solution, eye drops, or an injectable form.

Cyclosporine oral capsule is available as the brand-name drugs Gengraf, Neoral, and Sandimmune. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version.

Why it's used

Cyclosporine is used to prevent rejection of a transplanted organ. It’s also used to reduce inflammation in active rheumatoid arthritis (RA) and severe psoriasis.

The brand-name version called Sandimmune is only used to prevent rejection of a transplanted organ.

How it works

Cyclosporine belongs to a class of drugs called immunosuppressants. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Cyclosporine works by weakening your immune system. White blood cells, part of your immune system, normally fight substances in your body that aren’t there naturally, such as a transplanted organ. Cyclosporine stops white blood cells from attacking a transplanted organ.

In the case of RA or psoriasis, cyclosporine stops your immune system from mistakenly attacking your own body tissues.

Cyclosporine side effects

Cyclosporine oral capsule doesn’t cause drowsiness, but it can cause other side effects.

More common side effects

The more common side effects that occur with cyclosporine include:

  • high blood pressure
  • low magnesium levels in your body
  • blood clots in your kidneys
  • stomach pain
  • hair growth in certain areas
  • acne
  • tremors
  • headache
  • increased size of your gums

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • liver damage. Symptoms may include:
    • blood in urine
    • dark urine
    • pale stools
    • yellowing of your skin or the whites of your eyes
    • pain in your upper abdomen
  • kidney damage. Symptoms may include:
    • blood in urine
  • heart problems. Symptoms may include:
    • swelling of your feet or lower legs
  • lung problems. Symptoms may include:
    • trouble breathing

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Cyclosporine may interact with other medications

Cyclosporine oral capsule can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with cyclosporine are listed below.

Antibiotics

Taking cyclosporine with certain antibiotics may lead to higher levels of cyclosporine in your body. This may increase your risk of side effects, especially kidney damage. Examples of these drugs include:

  • ciprofloxacin
  • gentamicin
  • tobramycin
  • bactrim
  • azithromycin
  • clarithromycin
  • erythromycin
  • quinupristin/dalfopristin

The following antibiotics may decrease the amount of cyclosporine in your body. This may cause cyclosporine not to work as well as it should. When cyclosporine is used to prevent rejection, this could lead to rejection of a transplanted organ. These drugs include:

  • nafcillin
  • rifampin

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Taking cyclosporine with these drugs may increase your risk of kidney damage. Examples of these drugs include:

  • ibuprofen
  • sulindac
  • naproxen
  • diclofenac

Antifungals

Taking cyclosporine with certain antifungal drugs may lead to higher levels of cyclosporine in your body. This may increase your risk of kidney damage. Examples of these drugs include:

  • amphotericin B
  • ketoconazole
  • fluconazole
  • itraconazole
  • voriconazole

Terbinafine, another antifungal, may decrease the amount of cyclosporine in your body. This may cause cyclosporine not to work as well as it should. When cyclosporine is used to prevent rejection, this could lead to rejection of a transplanted organ.

Acid reflux drugs

Taking cyclosporine with these drugs may increase your risk of kidney damage. Examples of these drugs include:

  • ranitidine
  • cimetidine

Birth-control drugs

Taking cyclosporine with drugs used for birth control may increase the amount of cyclosporine in your body. This may cause harmful side effects.

Immunity-suppressing drug

Tacrolimus can increase your risk of kidney damage if you take it with cyclosporine.

High cholesterol drugs

Taking cyclosporine with the following cholesterol drugs may increase your risk of kidney damage:

  • fenofibrate
  • gemfibrozil

When you take cyclosporine with other cholesterol drugs, the concentration of these drugs in your body may increase. This may cause side effects such as muscle pain and weakness. These drugs include:

  • atorvastatin
  • simvastatin
  • lovastatin
  • pravastatin
  • fluvastatin

Blood pressure drugs

These drugs may increase the amount of cyclosporine in your body. This may cause harmful side effects. Examples of these drugs include:

  • aliskiren
  • diltiazem
  • nicardipine
  • verapamil

Corticosteroid

Methylprednisolone may increase the amount of cyclosporine in your body. This may cause harmful side effects.

Anticonvulsants

These drugs may decrease the amount of cyclosporine in your body. This may cause cyclosporine not to work as well as it should. When cyclosporine is used to prevent rejection, this could lead to rejection of a transplanted organ. Examples of these drugs include:

  • carbamazepine
  • oxcarbazepine
  • phenobarbital
  • phenytoin

Herb

St. John’s wort may decrease the amount of cyclosporine in your body. This may cause cyclosporine not to work as well as it should. When cyclosporine is used to prevent rejection, this could lead to rejection of a transplanted organ.

Gout drugs

Allopurinol can increase the amount of cyclosporine in your body when it’s taken with cyclosporine. This may increase your risk of side effects.

Colchicine levels in your body can increase if this drug is taken with cyclosporine. This may increase your risk of side effects.

Hepatitis drugs

If you’re taking certain hepatitis drugs, check with your doctor before taking cyclosporine. Your doctor may need to reduce your dose of cyclosporine to prevent side effects. These drugs include:

  • boceprevir
  • telaprevir

Human immunodeficiency virus (HIV) drugs

If you’re taking drugs called protease inhibitors to treat HIV, check with your doctor before taking cyclosporine. Your doctor may need to reduce your dose of cyclosporine to prevent side effects. Examples of these drugs include:

  • indinavir
  • nelfinavir
  • ritonavir
  • saquinavir

Fluid-reducing drugs

Don’t take cyclosporine with these drugs. It may increase the amount of potassium in your body and may cause harmful side effects. These side effects may include a slow heart rate, fatigue, muscle weakness, and nausea. These drugs include:

  • triamterene
  • amiloride

Cancer drugs

Taking cyclosporine with these drugs may increase the amounts of those medications in your body. This may increase your risk of side effects. Examples of these drugs include:

  • ambrisentan
  • danorubicin
  • doxorubicin
  • etoposide
  • mitoxantrone

Taking melphan, another cancer drug, with cyclosporine may increase your risk of kidney damage.

Other drugs

Taking cyclosporine with any of the medications listed below may cause increased amounts of those medications in your body. This may increase your risk of side effects. These drugs include:

  • bosentan
  • dabigatran
  • digoxin
  • prednisolone
  • repaglinide
  • sirolimus

Other drugs may increase the amount of cyclosporine in your body. This may cause harmful side effects. These drugs include:

  • amiodarone
  • bromocriptine
  • danazol
  • imatinib
  • metoclopramide
  • nafazodone

Other drugs may decrease the amount of cyclosporine in your body. This may cause cyclosporine not to work as well as it should. When cyclosporine is used to prevent rejection, this could lead to rejection of a transplanted organ. Examples of these drugs include:

  • octreotide
  • orlistat
  • sulfinpyrazone
  • ticlopidine

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we can not guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

Cyclosporine warnings

This drug comes with several warnings.

Food interactions warning

Avoid eating grapefruit or drinking grapefruit juice when taking this medication. Consuming grapefruit products can increase the amount of cyclosporine in your body.

Warnings for people with certain health conditions

For people kidney and liver disorders: Cyclosporine may cause kidney and liver disease. If you already have kidney or liver problems, high doses of cyclosporine may make it worse.

For people with serious infections: Cyclosporine may increase your risk of serious viral infections, such as polyomavirus infection. This may be very serious and may even be fatal.

Warnings for other groups

For pregnant women: Cyclosporine is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk with your doctor if you’re pregnant or plan to become pregnant. Cyclosporine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

For women who are breastfeeding: Cyclosporine passes through breast milk and may cause serious negative effects. Tell your doctor if you’re breastfeeding. You and your doctor need to decide if you’ll breastfeed or take cyclosporine.

Brand-name Sandimmune capsules contain ethanol (alcohol). Ethanol and other substances in the drug may pass through breast milk and cause serious effects in a child who is breastfed.

For seniors: If you’re 65 years or older, you’re more likely to develop high blood pressure if you use cyclosporine. As you age, your organs, such as your liver and kidneys, don’t work as well as they once did. To prevent kidney damage, your doctor may start you on a lower dose.

For children:

  • Who have had a kidney, liver, or heart transplant: Children ages 6 months and older who received certain organ transplants and were treated with cyclosporine didn’t have unusual side effects.
  • Who have rheumatoid arthritis or psoriasis: The effectiveness and safety of cyclosporine haven’t been established in people younger than 18 years who have rheumatoid arthritis or psoriasis.

How to take cyclosporine

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Dosage for rheumatoid arthritis

Generic: Cyclosporine

  • Form: oral capsule
  • Strengths: 25 mg, 50 mg, and 100 mg

Brand: Gengraf

  • Form: oral capsule
  • Strengths: 25 mg, 50 mg, and 100 mg

Brand: Neoral

  • Form: oral capsule
  • Strengths: 25 mg and 100 mg

Adult dosage (ages 18 years and older)

  • Dosage is based on weight.
  • The initial dose is 2.5 mg/kg per day, divided into two doses.
  • The maximum dose is 4 mg/kg per day.
  • If you don’t get good results after 16 weeks of treatment, stop taking cyclosporine.

Child dosage (ages 0–17 years)

Dosage hasn’t been established for people younger than 17 years old.

Dosage for psoriasis

Generic: Cyclosporine

  • Form: oral capsule

  • Strengths: 25 mg, 50 mg, and 100 mg

Brand: Gengraf

  • Form: oral capsule
  • Strengths: 25 mg, 50 mg, and 100 mg

Brand: Neoral

  • Form: oral capsule
  • Strengths: 25 mg and 100 mg

Adult dosage (ages 18 years and older)

  • Dosage is based on weight.
  • The initial dose is 2.5 mg/kg per day, divided into two doses (1.25 mg/kg per dose).
  • The maximum dose is 4 mg/kg per day.
  • If you don’t get good results after 6 weeks of treatment, stop taking cyclosporine.

Child dosage (ages 0-17 years)

Dosage hasn’t been established for people younger than 17 years old.

Dosage to prevent rejection of kidney, liver, and heart transplants

Generic: Cyclosporine

  • Form: oral capsule
  • Strengths: 25 mg, 50 mg, and 100 mg

Brand: Gengraf

  • Form: oral capsule
  • Strengths: 25 mg, 50 mg, and 100 mg

Brand: Neoral

  • Form: oral capsule
  • Strengths: 25 mg and 100 mg

Brand: Sandimmune

  • Form: oral capsule
  • Strengths: 25 mg, 50 mg, and 100 mg

Adult dosage (ages 18 years and older)

The dosage of cyclosporine may vary, depending on your body weight, the organ that has been transplanted, and other medications you’re taking.

  • Generic and all brands except Sandimmune: Dosage may vary. The typical daily dose is 7–9 mg per kilogram (kg) of body weight taken in two even doses spaced evenly throughout the day.
  • Sandimmune:
    • Take your first dose 4–12 hours before your transplant. This dose is typically 15 mg/kg. Your doctor may give you a dose that’s 10–14 mg/kg per day.
    • Continue taking the same dose after your transplant surgery for 1–2 weeks. After that, reduce it by 5 percent per week to a maintenance dose of 5–10 mg/kg per day.

Child dosage (ages 1–17 years)

The dosage of cyclosporine will vary, depending on your child’s body weight, the organ that has been transplanted, and other medications your child is taking.

  • Generic and all brands except Sandimmune: Dosage may vary. The typical daily dose is 7–9 mg per kilogram (kg) of body weight taken in two even doses spaced evenly throughout the day.
  • Sandimmune:
    • Take your first dose 4–12 hours before your transplant. This dose is typically 15 mg/kg. Your doctor may give you a dose that’s 10–14 mg/kg per day.
    • Continue taking the same dose after your transplant surgery for 1–2 weeks. After that, reduce it by 5 percent per week to a maintenance dose of 5–10 mg/kg per day.

Child dosage (ages 0–11 months)

Dosage hasn’t been established for children younger than 1 year.

Special dosage considerations

  • For people with kidney disorders: Cyclosporine may cause kidney disease. If you already have kidney problems, your doctor may reduce your dose of cyclosporine.
  • For people with liver disorders: Cyclosporine may cause liver disease. If you already have liver problems, your doctor may reduce your dose of cyclosporine.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Take as directed

Cyclosporine is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you don't take it at all: Your body may reject your transplanted organ, or your symptoms of RA or psoriasis may return.

If you stop taking it suddenly: Don’t stop taking this medication. If you do, your body may reject your transplant, and you may experience increased side effects. Your symptoms of RA or psoriasis may return.

If you don't take it on schedule: Your body may reject your transplant, causing serious health problems. Your symptoms of RA or psoriasis may return.

What to do if you miss a dose: If you miss a dose, take it as soon as you can. However, if it’s just a few hours until your next dose, skip the missed dose.

Don’t try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: You may be able to tell the drug is working if:

  • Your body doesn’t reject the transplanted organ or tissue.
  • You have fewer rheumatoid arthritis symptoms.
  • You have fewer psoriasis plaques.

Important considerations for taking cyclosporine

Keep these considerations in mind if your doctor prescribes cyclosporine for you.

General

  • Take cyclosporine at the same time every day.
  • Don’t crush, chew, or cut cyclosporine capsules.

Storage

  • Store at room temperature between 68°F and 77°F (20C° and 25C°).
  • Once opened, use the medication within two months.
  • Keep this drug away from light and high temperature.
  • Note that you may detect an odor when you open the container for the first time. This will disappear over time.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.
  • Talk to your pharmacist before you travel to be sure you have enough of this medication. Depending on where you travel, you may have trouble getting this drug.

Self management

If you’re taking generic cyclosporine or a brand-name drug other than Sandimmune, avoid excessive sunlight or tanning booths.

Clinical monitoring

Your doctor may monitor you with certain blood tests before and during treatment with cyclosporine. This is to make sure it’s safe for you to take. Tests may be done to check things such as your:

  • cyclosporine levels
  • liver function
  • kidney function
  • cholesterol levels
  • magnesium level
  • potassium level

Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained here in is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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