Systemic Medications: Cyclosporine

What is cyclosporine and how does it work?

Cyclosporine is an immunosuppressive drug that was first used to help prevent rejection in organ transplant patients. In 1997, the Food and Drug Administration (FDA) approved Neoral for adults with severe psoriasis and otherwise normal immune systems.

Cyclosporine suppresses the immune system and slows down the growth of certain immune cells.

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How is it used?

Cyclosporine is taken daily by mouth in capsule or liquid form. The liquid form must be diluted for use, preferably mixed with room temperature orange or apple juice. Do not mix with grapefruit juice. Cyclosporine must be taken on a consistent schedule.

Cyclosporine can provide rapid relief from symptoms. You may see some improvement in symptoms after two weeks of treatment, particularly with stronger doses. However, it may take from three to four months to reach optimal control.

Extended use of cyclosporine by transplant patients is well-established. However, long-term use as a treatment for psoriasis is more limited. The FDA recommends cyclosporine not be used for longer than one year. However, there are no specific guidelines for how long you should stay off of cyclosporine before resuming treatment. Some doctors may prescribe the drug for more than one year.

Who should not take cyclosporine?

Do not take cyclosporine if you have:

  • A compromised immune system
  • Abnormal kidney function
  • High blood pressure
  • Cancer, or a history of cancer (other than basal or squamous cell skin cancers)
  • Severe gout

Additionally, do not take cyclosporine if you are:

  • Pregnant or breastfeeding
  • Undergoing radiation treatment.

What are the risks?

Individuals previously treated with PUVAmethotrexate or other immunosuppressive agents UVBcoal tar, or radiation therapy are at an increased risk of developing skin cancer when taking cyclosporine. Additional risks with cyclosporine include kidney damage. This increases with length of time and amount of cyclosporine taken. Your doctor will monitor your kidney function before and during treatment. Patients can also develop hypertension on this medication so frequent blood pressure checks are important.

Vaccinations may be less effective if taken while on cyclosporine. Talk to your doctor if you plan to get any kind of vaccination.

What are the side effects?

  • Decreased kidney function
  • Headache
  • High blood pressure
  • High cholesterol
  • Excessive hair growth
  • Tingling or burning sensation in the arms or legs
  • Skin sensitivity
  • Increased growth of gum tissues
  • Flu-like symptoms
  • Upset stomach
  • Tiredness
  • Muscle, bone or joint pain

Potential drug interactions with cyclosporine

Your doctor should always be aware of any other medications, treatments or dietary supplements you are using. Many medications interact with cyclosporine. These include certain antibiotics, anti-inflammatory drugs, anti-fungals, gastrointestinal agents, calcium channel blockers, and anti-convulsants. OTC medications such as aspirin and ibuprofen. Also, talk to your doctor if you are taking St. John's Wort while on cyclosporine.

Avoid grapefruit while taking cyclosporine and talk to your doctor about the amount of potassium-rich foods such as bananas, tomatoes, raisins and carrots you may have in your diet. Cyclosporine can raise the levels of potassium in your blood.

Can cyclosporine be used with other treatments?

Cyclosporine can be used with the topical drugs Dovonex and Vectical. When using these topicals, lower doses of cyclosporine may be given, lessening the risk of side effects.