Cyclosporin (Intravenous)

Cyclosporine, or Sandimmune, is a drug used intravenously to help prevent the rejection of transplanted organs.

The drug Cyclosporine, also known by the brand name Sandimmune, is given intravenously to help transplant patients prevent organ rejections. It belongs to a group of drugs that are referred to as immunosuppressive agents. The white cells of the human body will work to reject a transplanted organ, so it is imperative that this type of drug be used to help prevent rejection.

There are many risks associated with the use of this drug. It is known to have a wide variety of side effects that can be either unpleasant or life-threatening. It is important to discuss the use of this medication with your doctor so you are well informed of the risks prior to beginning this treatment. Before you begin a treatment with cyclosporine, you should tell your doctor about your complete medical history including all medical events, disease, and risks. You should also disclose all medications you are currently taking as well as any medications you may need to take during your course of treatment with cyclosporine. If you have allergies, specifically if you are allergic to castor oil. This drug increases your risk of infection, cancer, and other serious conditions.In some cases, you may not be able to be treated with this drug if you have some types of cancer, kidney dysfunction or disease, hypertension that is not well controlled, psoriasis treated with methotrexate, coal tar, radiation, PUVA, or UVB. Cyclosporin has also been known to cause kidney failure and requires close monitoring and frequent testing to ensure that it is not creating harmful effects on the patient's body.

Condition treated

  • Organ transplant

Type Of Medicine

  • Immune suppressant

Side Effects

This drug is known to have a wide variety of side effects that range from moderate to severe. If you begin to experience any of the symptoms listed, you should notify your doctor. If the side effects are severe, you may require emergency medical treatment. Do not take any other medication other than those approved by your doctor because it increases the likelihood you will experience side effects and interactions. Discuss your current medications and take any prescribed drugs as directed by your doctor.

  • Black tarry stools

This side effect may be the result of an intolerance or an underlying medical condition developing as a result of this treatment.

  • Blurred vision

If you begin to experience blurred vision, you may need to seek another form of treatment. Blurred vision is a severe side effect and should be addressed immediately.

If you begin to have chest pain, you may be having an emergency medical event. Seek treatment right away to help prevent a life-threatening condition.

  • Chills

Chills can be a sign of a developing infection, which is a risk associated with treatment using cyclosporine. If you have chills you will require immediate medical attention to help determine the cause of the side effect.

  • Clay-colored stools

If you develop clay-colored stools, you should alert your healthcare provider because there may be an underlying condition developing.

  • Cloudy urine

Cloudy urine is a sign of dehydration in some instance, which could be caused by a variety of medical issues related to your condition. You should tell your medical team if you notice any unusual colored or cloudy urine.

  • Cough

A cough developed while taking this treatment may be a sign of intolerance, allergic reaction, or a developing infection or other medical condition.

  • Dark urine

Dark urine could be an indicator of either dehydration or a condition that causes blood in your urine, which could be a serious side effect of cyclosporin.

  • A decrease in urine output

This medication is known to cause issues with kidneys, including kidney failure. It is important to monitor your urine output and report any abnormalities including a reduce in urine output even with a proper fluid intake.

  • Decreased appetite

In some cases, this treatment can cause a decrease in your appetite, which is a mild side effect.

If you become dizzy while taking cyclosporine, you may be developing an intolerance, or you could be having an allergic reaction, which should be immediately addressed.

  • Drowsiness

Some individuals may experience drowsiness associated with treatment with cyclosporine. If this condition worsens or becomes severe, you may need to be treated with another drug.

Developing a fever when you are taking this drug can be caused by an underlying infection, rejection, an intolerance, or may be the sign organ failure. Alert your medical team immediately if you suspect you are running a fever while taking cyclosporine.

You may develop a headache when undergoing treatment with cyclosporine, but if a headache is severe or pounding, you may be having an adverse reaction to the drug and should seek medical treatment.

  • Itching

Itching, especially when associated with a rash, can be a sign of an allergic reaction that requires immediate treatment.

  • Loss of appetite

If you notice a complete loss of appetite, you should alert your healthcare provider.

  • Muscle spasms or twitching

Muscle spasms and twitching is a serious side effect and should be addressed right away.

  • Nausea and vomiting

People who do not tolerate this medication well may be nauseated or may begin to vomit. Report this condition to your medical team.

  • Nervousness

Nervousness can be a sign of intolerance to cyclosporine and may require you to take a different course of treatment.

  • Painful or difficult urination

Urinary pain and discomfort can signal a severe side effect associated with the kidneys.

  • Pounding in the ears

This drug is known to cause issues for people who have hypertension and can cause a person to develop a pounding in their ears. Report this condition to your medical staff.

  • Shakiness in the legs, arms, hands, or feet

Shakiness is a sign of severe side effects and requires treatment and possibly a change of treatment.

  • Shortness of breath

Shortness of breath can signal an allergic reaction, or it could be a sign of a serious developing medical condition.

A skin rash or hive can be associated with an allergic reaction and requires medical attention.

  • Slow or fast heartbeat

If this drug affects your heartbeat you may need to be treated with another type of medication.

A sore throat can be caused by a developing infection that is a result of treatment with cyclosporine.

  • Sores, ulcers, or white spots on the lips or mouth

This serious side effect is associated with an intolerance to this drug.

  • Swelling of the feet or legs

Any swelling in the feet or legs can signal poor bodily function caused by treatment with this medication.

  • Swollen glands

Swollen glands can signal an infection that is a result of treatment with cyclosporine, or it can be a sign of rejection.

  • Trembling or shaking hands

Trembling or shaking of the hands can signal intolerance.

  • Bleeding or bruising that is unusual

You may notice that you bruise or bleed more easily when taking this drug. Monitor your condition closely.

  • Tiredness or weakness

This drug is strong and may cause some patients to experience tiredness or weakness. If the symptoms are severe, you should report it to your medical team for evaluation.

  • Yellowed skin or eyes

Any yellowing of the eyes or the skin is a sign of liver dysfunction which is a serious condition that can be caused by the use of cyclosporine.

Less common:

  • Bleeding gums

You may experience bleeding gums when taking this treatment.

  • Blood in the urine

If you notice blood in your urine, you should report it immediately because it is a sign of a serious condition.

  • Blood in the vomit

Blood in your vomit can indicate a life-threatening situation.

  • A Burning, crawling, itching, numbness, prickling, or tingling feeling

Any of these signs can indicate an intolerance to cyclosporine, or it can be symptoms of an allergic reaction.

  • Convulsions

Convulsions are a sign of a developing life-threatening situation that requires emergency medical attention.

  • Difficulty swallowing

Difficulty swallowing can signal a life-threatening symptom of an allergic reaction called anaphylaxis.

Hives are a symptom of an intolerance or allergic reaction to cyclosporine.

  • Pale skin

Pale skin is a sign of a deteriorating medical condition that may need immediate attention.

  • Pinpoint red spots on the skin

If you notice any red spots on the skin, you should tell your healthcare provider because you could be developing a serious side effect.

  • Puffiness, swelling of the eyelids, around the eyes, face, lips, and tongue

Any of these side effects can be a result of anaphylaxis or a severe reaction to cyclosporine.

  • Stomach pain

If you begin to experience severe or continuing stomach pain, you should alert your medical team because you could be having an emergency medical event.

  • Tightness in the chest

If you notice a tightness in the chest, you may be having an emergency medical event that requires immediate attention.

  • Troubled breathing

If you experience trouble breathing, especially with exertion, you may be having signs of an infection, reaction, or rejection.

Rare:

  • Bloating

Although rare, bloating is a mild side effect of this drug, and may be treated with an additional medication approved by your attending physician.

  • Chest discomfort

Chest discomfort can be a sign of a serious medical event.

Although rare, constipation is a mild side effect that can be relieved with medication prescribed by your doctor.

  • Discolored urine

Urine discoloration can be a sign of a developing medical condition related to your kidneys. Tell your healthcare team about any changes to your urine color or output.

  • Hoarseness

Hoarseness as a result of treatment with cyclosporine is rare and can be a symptom of a developing illness or infection.

If you have issues with indigestion while taking cyclosporine, you should ask your doctor what your treatment options are to help you control this side effect.

  • Lower back, side pain

Any pain in the side or the lower back can be a result of issue related to your kidneys that may result from the treatment with cyclosporine.

  • Night sweats

If you experience night sweats, it may be a side effect or could be a result of a developing infection or rejection of your transplanted organ.

  • Pain or discomfort in the arms, jaw, back, or neck

If you notice severe pain or discomfort in your neck, back, jaw, or arm, you may be experiencing an emergency medical event or even a severe side effect that requires attention.

  • Pains in the stomach, side, or abdomen, and back

If you notice pain in the stomach, side, abdomen, or back, you should alert your medical team immediately because you may be having a developing medical condition such as organ failure, or your body may be rejecting your transplanted organ.

  • Sweating

Sweating is a rare, but mild side effect. If the sweating is accompanied by other side effects or a fever you may be developing an infection or have an intolerance to the treatment.

  • Vomiting blood or material that looks like coffee grounds

If you begin to vomit blood or any material with a coffee ground texture, you are having either a severe reaction, or you are having a serious medical event that should be reported immediately to your doctor or medical team.

Dosage

The adult dose for organ transplant is 2 to 4 mg per day by IV over the course of four to six hours. An alternative to this recommended dose is 2 to 4 mg per day continuously by IV over the course of 24 hours. As the treatment progresses, the dose can be decreased over time and can be lowered to as little as 3 to 5 mg per day. The doctor will adjust the dose according to each individual patients needs at the time of transplant. If you begin to develop side effects or you can't tolerate your treatment, you may need to have your treatment switched to another drug.

Interactions

It is important to note that this drug interacts with a wide variety of medications, and posses a high disease interaction risk in some cases. Always discuss any allergies you have with your doctor before beginning this treatment. Discuss your complete medical history and any medications, supplements either herbal or over the counter, that you are currently taking. This will help to prevent the possibility of interactions and complications during your cyclosporine treatment. If you have decreased kidney or liver function, you may not be a good candidate for treatment with cyclosporine because it is known to make these conditions worse or cause them to occur. You should be monitored and tested frequently if you have decreased kidney function or liver impairment so your doctor or healthcare provider can develop any serious underlying issues that require immediate treatment.

Drugs with a major interactions risk:

The following drugs are not recommended for use with cyclosporine because they pose a very high interaction risk that could, in some cases, prove life-threatening or severe.

  • Dronedarone
  • Grazoprevir
  • Lercanidipine
  • Mifepristone
  • Pitavastatin
  • Simvastatin
  • Sitaxsentan
  • Amifampridine
  • Bosentan
  • Colchicine

There are several other medications that pose a moderate or low interaction risk, but may be necessary for the patient to continue, or begin taking, in order to prevent complications or medical conditions that pose a risk to the patient. Always consult with your doctor and take your medications exactly as directed.

Disease interactions:

  • Allergy to castor oil
  • Cancer
  • Eye problems
  • Hyperkalemia
  • Hypertension
  • Hyperuricemia, too much uric acid in the blood
  • Kidney disease
  • Liver disease
  • Precancerous skin changes or
  • Seizures
  • Thrombocytopenia or low number of platelets
  • Anemia
  • Bleeding problems
  • Brain disease

Warnings

Before you begin a treatment course with cyclosporine, you should thoroughly discuss the risks and benefits with your doctor. Because this drug poses a high interaction risk and may have several adverse side effects, you should discuss your complete medical history, as well as all of the medications and supplements, either prescription or over the counter, that you are currently taking. You should also discuss any medications you may need to take after your procedure to help lessen the risk of reactions and side effects later in your course of treatment. If you have an allergy to castor oil or any other allergies, you should tell your doctor. If you begin to develop an allergic reaction to this drug, you may require emergency medical treatment immediately. If you have any severe side effects or a combination of side effects, you should seek medical attention. Do not begin taking other medications without the consent of your doctor. Do not engage in any lifestyle behaviors that may interfere with your therapy such as drinking or taking recreational drugs.

Storage

This solution should be stored away from light and in plastic containers. Before preparing the injection the mixtures should be prepared in polyvinyl chloride minibags and in glass containers. The cyclosporine remains stable in a glass container in strict storage conditions outlined in the manufacturer's guidelines for up to 6 hours and 2 hours in the polyvinyl minibags. It is recommended that the solution is stored in a glass container to prevent drug concentration loss from the leaching of plasticizers from the polyvinyl minibags.

Summary

Cyclosporine (IV route) is a drug that is used to suppress the body's immune system in order to allow transplanted organs to avoid rejection by the body. This is a very potent drug that is known to carry a wide variety of side effects and can cause several issues for some patients. It is important to discuss these possibilities with your healthcare provider before treatment begins. Before you decide to undergo a procedure that requires the use of an immune suppressant such as cyclosporine, you should tell your doctor about your complete medical history, including all of your current and previous medical conditions. Discuss in detail all of your current medications, as well as any other medications you will need after your procedure. There is a high risk for both disease interactions as well as drug interactions. If you have decreased kidney function you may not be able to undergo treatment with this drug because it is known to cause kidney failure in some patients. If you have any hepatic dysfunction you should be closely monitored for jaundice or other problems related to the decreased function of the liver. Your doctor will also give you a list of medications, food, and lifestyle behaviors you should avoid when taking this medication. It is important to follow any guidelines set by your healthcare provider to ensure the best outcome and reduce the risk of side effects and interactions. Individuals who are allergic to castor oil are especially vulnerable to an allergic reaction during treatment with cyclosporine. It is also important to monitor your urine color and output because they are indicators of kidney function and any issues or discoloration should be reported.

This drug requires specific storage conditions that are outlined in the manufacturer's pamphlet. This drug should be administered via IV for the specified time, which may be an all-day schedule, or could be only 4 to 6 hours per day. The specific dose and schedule should be determined by your doctor and administered after your organ transplant. If you begin to experience adverse side effects or an allergic reaction, you should alert your medical staff immediately to prevent a life-threatening medical event.