Description
Cyclosporine (Gengraf, Neoral, Sandimmune) is a drug that decreases the pain and swelling of arthritis. It also may slow down progression of arthritis over time. It originally was used to prevent rejection in individuals after a kidney transplant.
Fast Facts
- Cyclosporine is sometimes used to treat joint swelling in rheumatoid arthritis and other autoimmune conditions.
- Cyclosporine has frequent drug interactions.
- Regular monitoring of blood pressure and kidney function are needed while on this medication.
- The risk of some viral infections and other infections may be increased while taking cyclosporine.
Uses
Cyclosporine is used to treat people with rheumatoid arthritis who have not responded well to other medications. It also is used to treat other rheumatic conditions and severe forms of psoriasis.
How it works
Cyclosporine works on cells, known as T-lymphocytes, which are important in the immune system. These cells are involved in autoimmune diseases, such as rheumatoid arthritis, psoriasis, myositis and lupus.
Dosing
Cyclosporine dosage is determined by body weight. The initial dose for cyclosporine is 2.5 milligrams per kilogram (mg/kg) of body weight per day. This is then increased depending on how effective and well tolerated treatment is. Cyclosporine comes in 25 mg and 100 mg capsules and usually is taken twice a day. The daily dose usually works out to 75 mg or 100 mg taken twice daily. Your physician may increase the dose more in some situations.
Time to effect
Cyclosporine may take a week or more before having any effect on arthritis symptoms. Maximum benefits may not be noticed for 3 months.
Side effects
The most common and potentially serious side effects are high blood pressure and kidney problems. Both problems are more likely to occur in elderly people who take this medication. Up to a quarter of patients taking cyclosporine for rheumatoid arthritis develop elevated high blood pressure on this medicine. Around half of patients develop mild kidney problems while on this medication. This can require reducing the dosage or stopping of the medication. Kidney function usually improves after stopping the medication.
Cyclosporine can cause gout in some individuals or worsen underlying gout in others. Other common side effects include headaches, nausea, vomiting, abdominal pain or upset stomach, and swelling of the hands or feet. Some patients may develop tremors, increased hair growth, muscle cramps, or numbness and tingling of the hands or feet (known as neuropathy). Rarely, cyclosporine can cause swelling of the gums. Brushing and flossing regularly may help to prevent this.
Points to remember
You should not take cyclosporine if you have high blood pressure, kidney problems or cancer. Patients taking cyclosporine for a kidney transplant seem to have a higher risk of developing some kinds of cancers including skin cancers and, therefore, should have regular skin exams. Be sure to talk with your doctor before receiving any vaccines or undergoing any surgeries while on cyclosporine.
Cyclosporine may increase the risk of some kinds of infections. Notify your doctor if you notice signs of an infection, such as fever.
If you are pregnant or are considering having a child, discuss this with your doctor before beginning medication. Cyclosporine can cause serious complications during pregnancy such as pre-eclampsia (the development of high blood pressure and fluid retention which is also called toxemia of pregnancy) and pre-term labor. Although it is unclear if cyclosporine causes birth defects, this issue should be discussed with your doctor. Because cyclosporine passes into breast milk, you should not breast-feed while taking this medication.
Drug interactions
Cyclosporine interacts with many drugs. Be sure to tell your doctor about all of the medications you are taking, including over-the-counter drugs and natural remedies. The following partial list of medications may interfere with the effectiveness of cyclosporine:
Medications taken for the heart and blood pressure: diltiazem (Cardizem, Tiazac); nicardipine (Cardene); verapamil (Calan; Covera-HS, Isoptin, Verelan); and the potassium-sparing diuretics amiloride (Midamor), spironolactone (Aldactone) or triamterene (Dyrenium)
Cholesterol lowering medications: lovastatin (Mevacor) and simvastatin (Zocor)
Antibiotics and antifungals: clarithromycin (Biaxin), erythromycin, naficillin, fluconazole (Diflucan), intraconazole (Sporanox), ketoconazole (Nizoral), and rifampin (Rifadin, Rimactane)
Anti-seizure (anti-epileptic) medications: carbamazepine (Tegretol), phenobarbital (Solfoton), and phenytoin (Dilantin)
Antidepressants: nefazadone (Serzone) and the selective serotonin reuptake inhibitors (SSRIs) such as paroxitine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft)
Human immunodeficiency virus (HIV) protease inhibitors : indinivir (Crixivan), saquinavir (Fortovase, Invirase), ritonavir (Norvir), and nelfinavir (Viracept)
Others: allopurinol (Lopurin, Zyloprim), bromocryptine (Parlodel), androgens (male hormones), estrogens (female hormones), danazol (Danocrine), metoclopramide (Reglan), methylprednisolone, octreotide, ticlopidine (Ticlid), cimetidine (Tagamet), methoxsalen (Oxsoralen), coal tar (Balnetar, Zetar), trioxsalen (Trisoralen)
Avoid eating grapefruit and drinking grapefruit juice while taking this medication as it can affect the level of cyclosporine in your body.
Information to Discuss with Your Primary Care Physician and other Specialists
Be sure to notify your other physicians that you are taking this drug. Because cyclosporine has numerous possible drug interactions, you should discuss this when any new drug is started. Live vaccines should be avoided while on this medication, and you should discuss updating your vaccinations prior to starting this medication. Because this medication can lower your immunity, it is important you discuss this with any treating physician for an infection as this may lead to a different evaluation or treatment.
For more information
The American College of Rheumatology has compiled this list to give you a starting point for your own additional research. The ACR does not endorse or maintain these Web sites, and is not responsible for any information or claims provided on them. It is always best to talk with your rheumatologist for more information and before making any decisions about your care.
National Institutes of Health Medline Plus Cyclosporine link
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601207.html
National Institutes of Health Medline Plus Cyclosporine Injection link
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a684054.html
Updated November 2009
Written by Michael Cannon, MD, and reviewed by the American College of Rheumatology Patient Education Task Force.
This patient fact sheet is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnoses and treatment of a medical or health condition.
© 2010 American College of Rheumatology
