Neoral Information
What is Cyclosporine? Who will benefit from Cyclosporine?
Cyclosporine belongs to a class of medications called immunosuppressive agents. Quite simply, this means that the patient’s immune system is suppressed after taking this medication. This leads us to explain the most common use of Cyclosporine. It is commonly used following transplant surgery (ex. kidney). When a patient receives a transplant, the immune system (the body’s own system for fighting disease, flu, etc...) needs to be suppressed. If the immune system is not suppressed, the body will recognize the transplanted organ as foreign and begin to fight the transplanted organ and end up eventually destroying the transplanted new organ.
Cyclosporine used alone or with methotrexate (Rheumatrex) is also used to treat the symptoms of rheumatoid arthritis (arthritis caused by swelling of the lining of the joints) in patients whose symptoms were not relieved by methotrexate alone. Usually, only severe forms of Rheaumatoid Arthritis will be treated with Cyclosporine.
Cyclosporine (modified) is also used to treat psoriasis (a skin disease in which red, scaly patches form on some areas of the body) in certain patients who have not been helped by other treatments
Neoral Side Effects
Cyclosporine is an effective medication. However, its effectiveness must be outweighed versus the potential side-effects that it may cause. There is no doubt that Cyclosporine has one of the more extensive side-effect profiles in comparison to other drugs. Therefore, it is VERY IMPORTANT that the patient be aware of these side-effects and has a close follow-up with his/her physician.
Common side effects:
Nausea and vomiting. It was reported in 12% of patients treated with Cyclosporine for Rheaumatoid Arthritis. This will likely be worse when the patient first starts taking the medication and will vary in severity from patient to patient.
Infections (viral, bacterial, fungal). Infections will be very common when a patient is taking Cyclosporine, especially if he is on other medications to suppress the immune system (ex. Methotrexate). The patient must be aware of these infections and consult a doctor immediately; a simple infection can turn life-threatening. This is because, the patient’s immune system is being suppressed and the body will not generate a normal reaction to infections.
Pregnant women: This medication SHOULD NOT be taken by pregnant women as it has been shown to cause fetal harm.
Anemia: Cyclosporine may lead to severe drops in blood counts. It is advised that the patient obtains weekly blood tests during the first month of treatment, then twice monthly for the following second and third months. Then monthly or upon the physicians request.
Increased risk of certain cancers: Most commonly skin cancer, but may also include luekemia, lymphomas, non-Hodgkins lymphoma . This increased risk is common with any immunosuppressive drug. The risk also increases when Immunosuppressive drugs are combined. This risk is related to the intensity of immunosuppressant (the degree that the patient needs his/her immune system suppressed) and the duration (the time needed for therapy).
High blood pressure and kidney disease: The patient must monitor his/her blood pressure regularly and must get regular kidney function tests as Cyclosporine as long term therapy may cause kidney disease.
Headache and stomach upset: may occur, and if it does, will occur when the patient first starts the medication. This is considered a more minor side-effect.
SUMMARY
Cyclosporine is an effective drug, it is commonly used following organ transplants, and it has been proven to reduce the risk of organ rejection. It is also noted as an effective treatment in Rheumatoid Arthritis and Psoriasis. However, the patient should be informed of the side-effects of the medication, potential drug interactions and should take an active role in monitoring of potential side-effects (i.e. he should be aware of all side-effects and actively monitor and discuss with his physician/pharmacist or any other health professional).
Neoral Directions
What would make me stop taking Cyclosporine?
1) Severe nausea and vomiting.
2) Severe anemia.
3) Development of cancers or suspicion of cancers.
4) Pregnancy.
5) Development of kidney disease.
What dose of Cyclosporine should I take?
Cyclosporine comes in 4 doses, 10mg, 25mg, 50mg, and 100mg. Your dose will be determined by your physician. The dose will be calculated based on the condition being treated for (for example, doses for transplant patients will be significantly higher than doses for treatment of psoriasis and Rheumatoid Arthritis. The dose is based on the weight of the patient. Any changes to the dosage will be made slowly to try and balance the effectiveness versus any possible side-effects. The patient should NEVER modify his/her dosage without consulting the physician. And changes to dosage should only be made by a physician.
When will Cyclosporine be used to treat Psoriasis?
Cyclosporine is a very effective treatment. It is especially helpful for immediate control of severe disease. However, it will not be helpful as a long-term therapy (>1 year) due to renal (kidney) toxicity. Therefore, cyclosporine will be used in more severe cases.
Will Cyclosporine interact with my other drugs? Any food I should avoid?
There exist certain drugs that when taken together with Cyclosporine, can have the effect of reducing the effectiveness of Cyclosporine, increase the side-effects, or interact in another undesired way. This patient should be aware and discuss actively with his/her physician if he is on the following medications.
1) Allopurinol (gout medication)
2) ACE inhibitor class (Ramipril,Trandalopril, etc...Blood pressure class of medication)
3) Warfarin (Blood thinner)
4) Sulfa drugs
5) Certain cholesterol drugs
6) Phenytoin
This is not a complete list of drugs that may interact with Cyclosporine. The patient should discuss with her pharmacist/physician when they start Cyclosporine and if any other new medication will be taken when they are on Cyclosporine.