Cyclosporine Brand Names
Cequa | Gengraf | Neoral | Restasis | Sandimmune | SangCya
What is Cyclosporine
Cyclosporine is an oral and parenteral immunosuppressive agent. It is a cyclic polypeptide consisting of 11 amino acids and is produced by the fungus Beauveria nivea.
Cyclosporine is used to prevent allograft rejection; the drug has revolutionized transplantation by improving transplant survival, reducing hospitalization, and reducing patient morbidity.
Cyclosporine is also effective in various autoimmune conditions such as uveitis, psoriasis, type I diabetes mellitus, rheumatoid arthritis, inflammatory bowel disease, and certain nephropathies.
While many of these uses are still experimental, cyclosporine capsules and oral solution, USP (Modified) are approved by the FDA for the treatment of refractory rheumatoid arthritis and psoriasis.
Adverse reactions of cyclosporine treatment and the relapse of the conditions upon discontinuation of therapy limit the drugs use in autoimmune diseases. Ophthalmic formulations (i.e., solution and emulsion) are approved by the FDA to increase tear production in patients with ocular inflammation associated with keratoconjunctivitis sicca.
In October 2004, Chiron Corporation submitted an NDA to the FDA for Pulminiq (cyclosporine, USP) inhalation solution.
Fewer patients who received compounded cyclosporine by inhalation three times a week for 2 years after lung transplantation died (3 of 28) as compared with patients who received placebo (14 of 30) in addition to standard immunosuppression, but no difference between the groups was found for the main outcome, which was the rate of histologic acute rejection.
Despite an approvable status granted by the FDA, development of Pulminiq is currently arrested as per a decision by the manufacturer.
Indications
- aplastic anemia
- atopic dermatitis
- Crohn’s disease
- graft-versus-host disease (GVHD)
- graft-versus-host disease (GVHD) prophylaxis
- heart transplant rejection prophylaxis
- immune thrombocytopenic purpura (ITP)
- kidney transplant rejection prophylaxis
- liver transplant rejection prophylaxis
- lupus nephritis
- myasthenia gravis
- nephrotic syndrome
- psoriasis
- psoriatic arthritis
- rheumatoid arthritis
- ulcerative colitis
- xerophthalmia
Side Effects
- abdominal pain
- acne vulgaris
- acute respiratory distress syndrome (ARDS)
- alopecia
- anaphylactoid reactions
- anemia
- angioedema
- anorexia
- anxiety
- appetite stimulation
- arthralgia
- arthropathy
- asthenia
- ataxia
- azotemia
- BK virus-associated nephropathy
- bleeding
- blepharitis
- blurred vision
- bone fractures
- bronchospasm
- bullous rash
- candidiasis
- cataracts
- chest pain (unspecified)
- cholestasis
- confusion
- conjunctival hyperemia
- conjunctivitis
- constipation
- cough
- depression
- diabetes mellitus
- diarrhea
- dizziness
- drowsiness
- dysarthria
- dysgeusia
- dyspepsia
- dysphagia
- dyspnea
- dysuria
- eczema vaccinatum
- edema
- elevated hepatic enzymes
- emotional lability
- encephalopathy
- epiphora
- epistaxis
- eructation
- esophagitis
- fatigue
- fever
- flatulence
- flushing
- folliculitis
- foreign body sensation
- gastritis
- GI bleeding
- gingival hyperplasia
- gingivitis
- glossitis
- goiter
- gout
- gynecomastia
- headache
- hearing loss
- heart failure
- hematuria
- hemolytic anemia
- hemolytic-uremic syndrome
- hepatic failure
- hepatitis
- hiccups
- hirsutism
- hot flashes
- hyperbilirubinemia
- hyperchloremic acidosis
- hypercholesterolemia
- hyperesthesia
- hyperglycemia
- hyperkalemia
- hyperlipidemia
- hyperprolactinemia
- hypertension
- hypertrichosis
- hypertriglyceridemia
- hyperuricemia
- hypoesthesia
- hypoglycemia
- hypomagnesemia
- immunosuppression
- increased urinary frequency
- infection
- infertility
- influenza
- insomnia
- jaundice
- lethargy
- leukoencephalopathy
- leukopenia
- leukorrhea
- libido decrease
- libido increase
- lymphadenopathy
- lymphoma
- malaise
- menstrual irregularity
- metabolic acidosis
- migraine
- muscle cramps
- musculoskeletal pain
- myalgia
- myocardial infarction
- nausea
- nephrotoxicity
- new primary malignancy
- night sweats
- nocturia
- ocular discharge
- ocular inflammation
- ocular irritation
- ocular pain
- ocular pruritus
- pancreatitis
- papilledema
- paresthesias
- peptic ulcer
- peripheral neuropathy
- pharyngitis
- polyuria
- pruritus
- psoriasis
- pulmonary edema
- purpura
- rash
- renal tubular necrosis
- rhinitis
- seizures
- sinus tachycardia
- sinusitis
- skin cancer
- skin ulcer
- spermatogenesis inhibition
- stomatitis
- thrombocytopenia
- thrombosis
- tinnitus
- tremor
- urinary incontinence
- urinary urgency
- urticaria
- vertigo
- visual impairment
- vomiting
- weakness
- weight gain
- weight loss
- wheezing
- xerosis
- xerostomia
Monitoring Parameters
- CBC
- cyclosporine concentrations
- LFTs
- serum bilirubin
- serum creatinine/BUN
- serum electrolytes
- serum lipid profile
- serum uric acid
- skin cancer screening exam
Contraindications
- alcoholism
- biliary tract disease
- breast-feeding
- children
- contact lenses
- electrolyte imbalance
- encephalopathy
- fungal infection
- geriatric
- gout
- hepatic disease
- herpes infection
- herpes simplex keratitis (dendritic keratitis)
- hyperkalemia
- hypertension
- hyperuricemia
- hypomagnesemia
- immunosuppression
- infants
- infection
- jaundice
- lymphoma
- nephrotoxicity
- new primary malignancy
- ocular infection
- polyoxyethylated castor oil hypersensitivity
- pregnancy
- radiation therapy
- renal disease
- renal failure
- renal impairment
- requires a specialized care setting
- requires an experienced clinician
- skin cancer
- sunlight (UV) exposure
- vaccination
- varicella
- viral infection
Interactions
- Abatacept
- Abemaciclib
- Acalabrutinib
- Acarbose
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine; Dihydrocodeine
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- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetazolamide
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- Afatinib
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- Allopurinol
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- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Amobarbital
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- Hydrochlorothiazide, HCTZ; Irbesartan
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