Sandimmune

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Neoral, Sandimmune, |Sandimmune

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Sandimmune

Generic Name: cyclosporine (sye kloe SPOE rin)
Brand Names: Neoral, Sandimmune

What is cyclosporine?

Cyclosporine is an immunosuppressant. Immunosuppressants decrease the effects of your body"s immune system.

Cyclosporine is used to prevent your body from rejecting a kidney, liver, or heart transplant. Cyclosporine may be used in combination with another immunosuppressant and a steroid medication. Some brands of cyclosporine (e.g. Neoral) are also used to treat severe rheumatoid arthritis and severe psoriasis.

Although not approved by the FDA for these purposes, cyclosporine has also been used in the treatment of pancreatic, corneal, bone marrow, and heart/lung transplants; alopecia areata; aplastic anemia; atopic dermatitis; Behcet"s disease, biliary cirrhosis, Chron"s disease; ulcerative colitis; diabetes; lichen planus; lupus nephritis; multiple sclerosis; myasthenia gravis; and other diseases.

Cyclosporine may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about cyclosporine?

Notify your doctor immediately if you develop fever or chills, a sore throat, unusual bleeding or bruising, mouth sores, abdominal pain, pale stools, or darkened urine. These symptoms could be early signs of dangerous side effects.

Tell your doctor and dentist that you are taking this medication before having surgery, before starting any other medicines, and before receiving any vaccinations.

Although Sandimmune and Neoral are both brands of cyclosporine, they do not provide equivalent doses. Do not switch brands of this medication without first talking to your doctor. A dosage adjustment is necessary when you switch brands.

Do not consume grapefruit or grapefruit juice during treatment with cyclosporine unless specifically directed otherwise by your doctor. Cyclosporine can interact with grapefruit and grapefruit juice and the interaction may have dangerous effects. You should discuss the use of grapefruit and grapefruit juice with your doctor.

What should I discuss with my healthcare provider before taking cyclosporine?

Before taking cyclosporine, tell your doctor if you have

  • liver disease;

  • kidney disease;

  • cancer;

  • high blood pressure;

  • a viral, bacterial, or fungal infection;

  • undergone treatment with PUVA, UVB, methotrexate (Rheumatrex, Immunex), coal tar, radiation, or other immunosuppressants; or

  • any other serious or chronic medical condition.

You may not be able to take cyclosporine, or you may require a lower dose or special monitoring if you have any of the conditions listed above.

Cyclosporine is in the FDA pregnancy category C. This means that it is not known whether cyclosporine will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant or become pregnant Dur ring treatment. Cyclosporine passes into breast milk and may harm a nursing infant. Cyclosporine is not recommended for use during breast-feeding. Do not take cyclosporine without first talking to your doctor if you are breast-feeding a baby.

How should I take cyclosporine?

Take cyclosporine exactly as directed by your doctor. If you do not understand these directions, ask your doctor, nurse, or pharmacist to explain them to you.

Take each dose with a full glass of water.

Take cyclosporine at the same time(s) each day and in the same relation to meals. For example, take your medication always with a meal, always 1 hour before a meal, or always 1 hour after a meal. Food can alter the amount of cyclosporine that gets absorbed into your body, and it is important to keep your routine as consistent as possible.

The Sandimmune oral solution can be mixed with milk, chocolate milk, or orange juice at room temperature. The Neoral oral solution can be mixed with apple or orange juice at room temperature; it should not be mixed with milk. Do not mix Sandimmune or Neoral with grapefruit juice. To regulate your doses, try to mix your medication with the same beverage as often as possible. Measure the required amount with the syringe provided, then transfer it to the beverage. Use a glass container, not a plastic one, to hold the mixture. Stir well, then drink the mixture immediately. Do not allow it to stand. Put some more of the beverage into the same glass, swirl it around, and drink this too. This process will ensure that you get all of the cyclosporine that is prescribed for you.

To ensure that you get a correct dose, measure the liquid form of cyclosporine with the syringe provided. Do not rinse the syringe before or after use. Even the smallest bit of water will alter the dose of cyclosporine that you measure, and variations in the dose could become dangerous. If the syringe needs to be rinsed, be sure that it is completely dried before measuring a dose.

Do not consume grapefruit or grapefruit juice during treatment with cyclosporine unless specifically directed otherwise by your doctor. Cyclosporine can interact with grapefruit and grapefruit juice and the interaction may have dangerous effects. You should discuss the use of grapefruit and grapefruit juice with your doctor.

Your doctor will probably want you to have regularly scheduled blood tests and other medical evaluations during treatment with cyclosporine to monitor progress and side effects.

Although Sandimmune and Neoral are both brands of cyclosporine, they do not provide equivalent doses. Do not switch brands of this medication without first talking to your doctor. A dosage adjustment is necessary when you switch brands.

Store cyclosporine at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the dose you missed, and take only your next regularly scheduled dose. Do not take a double dose of this medication unless otherwise directed by your doctor. Notify your doctor if you miss a dose of this medication.

What happens if I overdose?

Seek emergency medical attention.

Symptoms of a cyclosporine overdose are not known.

What should I avoid while taking cyclosporine?

Do not consume grapefruit or grapefruit juice during treatment with cyclosporine unless specifically directed otherwise by your doctor. Cyclosporine can interact with grapefruit and grapefruit juice and the interaction may have dangerous effects. You should discuss the use of grapefruit and grapefruit juice with your doctor.

Cyclosporine can lower the activity of the immune system making you more susceptible to infection. Avoid contact with people who have colds, the flu, or other contagious illnesses. In addition, do not receive vaccines that contain a live strain of the virus (e.g., live oral polio vaccine) and avoid contact with individuals who have recently been vaccinated with a live virus. Notify your doctor at the first sign of fever, chills, or a sore throat

Tell your doctor and dentist that you are taking this medication before having surgery, before starting any other medicines, and before receiving any vaccinations.

Although Sandimmune and Neoral are both brands of cyclosporine, they do not provide equivalent doses. Do not switch brands of this medication without first talking to your doctor. A dosage adjustment is necessary when you switch brands.

Cyclosporine side effects

Notify your doctor immediately if you develop fever or chills, a sore throat, unusual bleeding or bruising, mouth sores, abdominal pain, pale stools, or darkened urine. These symptoms could be early signs of dangerous side effects. If you experience any of the following serious side effects, stop taking cyclosporine and seek emergency medical attention or contact your doctor immediately:
  • an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

  • unusual tiredness or weakness;

  • cough or hoarseness, fever, or chills;

  • painful or difficult urination;

  • severe nausea, vomiting, or diarrhea;

  • unusual bleeding or bruising;

  • seizures; or

  • a sudden unusual feeling of discomfort or illness.

Other, less serious side effects may also occur. Continue to take cyclosporine and notify your doctor if you experience

  • tremor (shaking);

  • increased bodily hair growth;

  • gum problems;

  • high blood pressure;

  • numbness or tingling; or

  • decreased appetite.

Immunosuppressant drugs such as cyclosporine increase your risk of certain types of cancer, such as lymphomas or skin cancer. Ask you doctor about the risks and benefits of cyclosporine in your treatment.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect cyclosporine?

There are many drug/drug interactions with cyclosporine and you should tell your doctor of any drugs you are on and any new drugs, including herbal products, you start. The interactions could alter cyclosporine levels causing a decrease in effectiveness or an increase in side effects. The side effects or effectiveness of the other drugs may also be altered.

The following are some examples of medicatoins that may result in a drug/drug interaction when taken with cyclosporine:

  • trimethoprim with sulfamethoxazole (Bactrim, Septra, Sulfatrim, others), gentamicin (Garamycin, others), and vancomycin (Vancocin);

  • ibuprofen (Advil, Motrin, Nuprin, others), naproxen (Naprosyn, Anaprox, Aleve, others), diclofenac (Voltaren, Cataflam), etodolac (Lodine), flurbiprofen (Ansaid), fenoprofen (Nalfon), indomethacin (Indocin), ketorolac (Toradol), ketoprofen (Orudis KT, Orudis, Oruvail), nabumetone (Relafen), oxaprozin (Daypro), piroxicam (Feldene), sulindac (Clinoril), and tolmetin (Tolectin);

  • amphotericin B (Fungizone) and ketoconazole (Nizoral);

  • tacrolimus (Prograf);

  • melphalan (Alkeran);

  • cimetidine (Tagamet, Tagamet HB) and ranitidine (Zantac, Zantac 75);

  • diltiazem (Cardizem, Dilacor XR, Tiazac), nicardipine (Cardene), amiodarone (Cordarone, Pacerone) and verapamil (Calan, Verelan);

  • ketoconazole (Nizoral), itraconazole (Sporanox), and fluconazole (Diflucan);

  • danazol (Danocrine) and methylprednisolone (Medrol, others);

  • erythromycin (Ery-Tab, E-Mycin, E.E.S., P.C.E., others), clarithromycin (Biaxin);

  • bromocriptine (Parlodel);

  • colchicine and allopurinol (Aloprim, Lopurin, Zyloprim);

  • indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), lopinavir-ritonavir(Kaletra) and saquinavir (Fortovase, Invirase);

  • metoclopramide (Reglan);

  • prednisolone (Prelone, Pediapred, others);

  • digoxin (Lanoxin, Lanoxicaps);

  • lovastatin (Mevacor), fluvastatin (Lescol), pravastatin (Pravachol), simvastatin (Zocor), or atorvastatin (Lipitor);

  • PUVA or UVB therapy; and

  • potassium-sparing diuretics (water pills) such as amiloride (Midamor), spironolactone (Aldactone, Spironol), or triamterene (Dyrenium); and

  • any type of vaccination.

Where can I get more information?

  • Your pharmacist has additional information about cyclosporine written for health professionals that you may read.

What does my medication look like?

Cyclosporine is available with a prescription under the brand names Sandimmune and Neoral. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

  • Sandimmune25 mg--oblong, pink capsules

  • Sandimmune 50 mg--oblong, yellow capsules

  • Sandimmune 100 mg--oblong, dusty-rose capsules

  • Sandimmune Oral Solution 100 mg/mL

  • Sandimmune Injection 50 mg/mL

  • Neoral 25 mg--oval, blue-gray capsules

  • Neoral 100 mg--oblong, blue-gray capsules

  • Neoral Oral Solution 100 mg/mL--clear yellow liquid

  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ("Multum") is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum"s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum"s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2006 Cerner Multum, Inc. Version: 2.05. Revision Date: 7/29/04 4:04:37 PM.




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