Ophthalmic cyclosporine is a liquid used as eye drops in the eyes to treat patients with chronic dry eye, or keratoconjunctivitis sicca, due to inflammation. In patients with chronic dry eye, tear production is decreased when white blood cells of the immune system die and accumulate in the tear gland. Cyclosporine, when applied directly to the eye, works locally as a partial modulator of the immune system by decreasing the swelling in the eye duct and increasing tear production. The effects of cyclosporine are not immediate and it may take three to six months after starting treatment to notice a difference in tear production.
• Keratoconjunctivitis sicca (KCS), also known commonly as chronic dry eye
There are several side effects that may be experienced by patients while taking cyclosporine. Consult a physician if any of the listed side effects become severe or persistently experiences, as this should not happen during the administration of cyclosporine. Side effects other than the ones listed are possible, but not all side effects are experienced by all patients. If the patient has any questions regarding side effects, they should contact their physician.
• Burning, itching, stinging, redness, or any pain or discomfort of the eyes
• Overflow of tears or watery eye
• Eye discharge (could be clear or yellow)
• Blurred vision or difficulty reading
• Feeling that something is in the eye
• Sticky or matted eyelashes
• Halos around lights
• Itching skin
Serious allergic reactions to cyclosporine are rare, but emergency medical help should be sought if the patient suffers from rash and swelling of the face, tongue, or throat, or severe dizziness and trouble breathing.
Only the prescribed dosage of cyclosporine from the physician should be taken by the patient and the patient should read any directions in the packaging. Each patient has different needs and knowing those needs, a physician can prescribe different dosages to each patient. The physician's specific instructions for each patient should be followed as closely as possible. When advised to do so, or if the medication becomes expired, patients should properly dispose of the remaining medication.
If a physician has prescribed cyclosporine, the patient should follow their instructions closely and read all of the information that accompanies the medication. Generic dosages from the manufacturer do exist as basic guidelines but may differ from the prescribed dosage. When in doubt, the dosage and frequency established by the physician should be observed above all. The physician, unlike the manufacturer, is able to factor in more specific information about the patient and will use that information to create an appropriate treatment plan.
Ophthalmic cyclosporine should be used only in the eyes and generic instructions prescribe the instillation in each eye twice a day, 12 hours apart. A general route for instillation of the drops is as follows.
1. Wash their hands thoroughly
2. Rotate, not shake, the vial of eye drops back and forth to mix the medication without opening the bottle
3. Open the bottle
4. Tilt their head back and press their finger gently on the skin just beneath the lower eyelid, creating a gap for the medication, while looking up
5. Administer the medication in this spot in the eye by tilting the bottle toward the eye without touching it
6. Remove their fingers from the eyelid
7. Close their eyes and perform nasolacrimal occlusion (gentle pressure with the index finger in the corner of the eye closest to the nose to minimize drainage)
8. Repeat steps four through seven with the other eye
If the eye drop misses, another drop should be applied. If any drops have landed on the face, the patient should wipe excess liquid away with a tissue. The patient’s hands should then be washed again after the eye drops have been applied to rid any medication that may have transferred on to the hands. The applicator tip of the eye drop bottle should not be touched to any surface in order to keep it germ-free. If the patient wears contact lenses, they should remove the lenses prior to applying the drops. The lenses can be replaced 15 minutes after the drops have been administered. Cyclosporine is also safe to use with artificial or lubricant tears, but a 15-minute interval should be allowed between products.
For adults and children 16 years of age and older, the recommended dosage from the manufacturer is one drop in each eye every 12 hours. For children younger than 16 years of age, a physician must be consulted for frequency and dosage.
The patient should avoid missing dosages in order to maximize the benefits from taking this medication. However, missed dosages sometimes happen. If a patient misses a dosage, they should evaluate when the next dosage is scheduled. If it is almost time for next dosage, skip the missed dosage and continue as scheduled. If it is not close to the time for the next scheduled dose, take the missed dose as soon as possible. Taking two dosages at the same time is not recommended. Ask a physician for additional advice about missing dosages.
Overdosing on cyclosporine can happen if the medicine is swallowed and can be harmful. If cyclosporine is swallowed, a patent can pass out or have trouble breathing. If a patient thinks an ingestion of cyclosporine has occurred, they need immediate medical attention found by either dialing 911 or the local Poison Control Center (1-800-222-1222).
Sometimes when used together, drugs can interact and the interaction between some medications may make one or all of the medications being taken ineffective or cause dangerous reactions. Some drug interactions are known and if a physician is informed about medications a patient is taking, the physician can avoid any harmful reactions by choose to not prescribe a medication, change a dosage or take other necessary precautions. The patient can keep a list of medications including the name, type, frequency of administration and dosage rate of any medications being taken to give to the physician. The list should not only include prescribed medications but non-prescribed medications, like over-the-counter medications or vitamins. These might also cause interference in the treatment plan being prescribed by the physician.
No major drug interactions have been noted with cyclosporine. Lubricant eye drops and artificial can be used with this medication, however, the application should be at least 15 minutes after the instillation of cyclosporine. The patient should inform their physician of any other treatments they are taking for their chronic dry eye so the physician can evaluate the best course of treatment.
The patient's physician should be notified if the patient is aware of any allergies to medications or specifically if an allergy exists with cyclosporine. They should also inform the physician of their medical history and current health problems. Knowing the information can help the physician make the most appropriate treatment plan.
Certain demographics have not had clinical studies done to conclude the safety and efficacy of administering cyclosporine and negative side effects for these demographics have not been recorded. For children younger than 16 years of age, the administration of cyclosporine has not been tested formally and there are no reports or clinical studies to evaluate the effects, safety or efficacy. Additionally, geriatric-specific problems have not been studied, but there are no indications that would limit the usefulness of the drug for the elderly.
In the case of pregnant women, there have been no formal studies, other than animal studies, to drawn conclusions about the effects to pregnant women and their fetuses. If a pregnant or breastfeeding patient has questions about the safety of using cyclosporine, they should contact a knowledgeable physician. The physician can help recognize the potential negative risks and weigh them with the potential benefits.
The patient should inform the physician of any eye drops they are currently taking for chronic dry eye, as well as if the patient has any eye infections, punctal plugs inserted or if they have ever had herpes of the eye. A punctal plug is a stopper that a doctor has inserted in a tear duct to direct tears into the eye. If the patient has contact lenses, they can still be worn, just not during the administration of the drops. The contact lenses can be reinserted 15 minutes after the drops have been administered.
Medications should be stored in the manner they will be the most effective. Storage information can be attained from a physician or pharmacist. Children and pets should not be able to access the medication and those who have not been prescribed this medication should not take it. Additional storage information can be found on the packaging or accompanying information. Medication past the expiration date is no longer effective and should be properly disposed of. The safest way to dispose of a medication is a take-back program but if one does not exist, consult a physician for instructions.
The manufacturer recommends that cyclosporine is stored in a tight and closed container at room temperature and away from light and moisture, out of the bathroom. If the seal has been broken on the bottle of cyclosporine the medication may have been tampered with and should not be used.
Cyclosporine can be applied in the eyes to successfully increase the body’s natural ability to produce tears in patients who suffer from chronic dry eye by reducing the inflammation of the tear ducts and stimulating tear production. The positive effects of cyclosporine cannot usually be noticed for up to 3 to 6 months after treatment has started. No major drug interactions exist but contact lenses should be removed during the instillation for 15 minutes, as well as no other eye drops be applied for that time. Few side effects exist with the most common being temporary burning of the eyes.