Cyclosporine (Neoral, Sandimmune, Gengraf)

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Cyclosporine (Neoral, Sandimmune, Gengraf) is a potent immunosuppressant drug used in treatment for rheumatoid arthritis, lupus, psoriasis, and other autoimmune diseases. Cyclosporine is considered a disease modifying anti-rheumatic drug (DMARD) because it not only helps treat the symptoms of arthritis but also decreases the progression of the condition thereby reducing the risk of long-term joint destruction and disability. 

Cyclosporine, originally used to prevent the rejection of transplanted kidneys, continues to be recommended for a variety of organ transplants. However, it has proven effective as a treatment for rheumatoid arthritis patients who have not responded well to other medications. It has also been used to treat those with other rheumatic conditions, inflammatory eye diseases, and severe forms of psoriasis and other autoimmune skin disorders. Cyclosporine is used even in pediatric rheumatology, in particular in the management of juvenile dermatomyositis and macrophage activation syndrome associated with systemic juvenile idiopathic arthritis.

How to Take It

Cyclosporine is taken by mouth one to two times per day. The starting dose is 2.5 mg/kg of body weight per day, which may be increased over time. Cyclosporine comes in 25 mg and 100 mg capsules, that may be taken twice a day. The daily dose usually works out to 75 mg or 100 mg taken twice daily. Your rheumatology provider may increase the dose to 4.5 mg/kg a day or higher in some situations. The capsules should not be crushed or chewed. Because cyclosporine can affect the immune system, it should be handled by caregivers with gloves. Cyclosporine can take several months to work and needs frequent blood test monitoring.

Side Effects

The most common and potentially serious side effects are high blood pressure and kidney problems, so make sure to drink plenty of water and stay well hydrated. Both problems are more likely to occur in elderly people who take this medication.  Cyclosporine may also increase the risk of some kinds of infections; notify your rheumatology provider if you notice signs of an infection, such as fevers.

Other possible side effects include headaches, nausea, vomiting, abdominal pain or indigestion, swelling of the hands or feet, tremors, increased hair growth, gum swelling, muscle cramps, or numbness and tingling of the hands or feet.

Tell Your Rheumatology Provider

Cyclosporine interacts with many medicines; consult with your rheumatology provider about medication interactions. Be sure to tell your healthcare provider about all of the medications you are taking, including over-the-counter drugs and homeopathic remedies. Let your rheumatology provider know if you have high blood pressure, kidney problems, or cancer, as cyclosporine can complicate these conditions.

Talk with your rheumatology provider before receiving any vaccines or undergoing any surgeries while on cyclosporine. You should discuss updating vaccines prior to starting cyclosporine. If you are pregnant or are considering having a child, discuss this with your doctor before beginning the medication. Cyclosporine can cause serious birth defects and should not be taken while pregnant or attempting to become pregnant or while breastfeeding. Contact your rheumatology provider if you have signs of an infection such as fever or chills, or if you are taking antibiotics.

Updated February 2022 by Mohammad Ursani, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

This patient fact sheet is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

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