Cyclosporine (Neoral®, Sandimmune®, Restasis®, Gengraf®)

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Last Modified: August 21, 2011

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Pronounced: SYE-kloe-SPOR-een
Classification: Immunosuppressant Agent

About Cyclosporine

Cyclosporine is a type of medication called an immunosuppressant and works primarily by inhibiting T lymphocytes. T lymphocytes are a type of white blood cell that is an important component of immune function.

How to Take Cyclosporine

Cyclosporine comes in a capsule or liquid formulation. There are two types of cyclosporine, the original version (Sandimmune®) and a version that is more rapidly available in your system (Neoral® and Gengraf®, also called modified cyclosporine). Because the body absorbs these two types of the medication differently, they are not interchangeable and you must be sure you receive the type your doctor prescribes. In addition, there are a few rules to follow when taking either type of cyclosporine:

  • Do not drink grapefruit juice while on this medication, as it interferes with the body's absorption of the medication.
  • Levels of the medication in your blood can vary and, for this reason, will be monitored with periodic blood tests.
  • The liquid form can be mixed in milk (regular or chocolate), orange or apple juice and should added to a glass (not a plastic container) containing the liquid. The mixture should be drunk right away and the glass filled with the liquid a second time and drunk to rinse any medication remaining in the glass.
  • Do not store in the refrigerator.

Restasis® is an eye drop formulation of cyclosporine that is used to treat chronic dry eyes resulting from ocular inflammation.

Many other medications, vitamins and herbs can interfere with cyclosporine levels in the blood. Be sure to let your healthcare team know about any medications or supplements you are taking.

Possible Side Effects of Cyclosporine

There are a number of things you can do to manage the side effects of Cyclosporine. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

High Blood Pressure

Cyclosporine can cause high blood pressure (hypertension). Your healthcare team will check your blood pressure periodically. You should report any signs of elevated blood pressure to your healthcare team, including headache, nosebleeds, ringing in the ears or dizziness.

Tremors

Tremors in the hands are common with cyclosporine, particularly when starting therapy or increasing the dose. These tend to decrease over time as your body adjusts to the medication.

Kidney Dysfunction

Cyclosporine can cause decreases in kidney function. For this reason, your healthcare team will monitor your kidney function with blood tests while taking cyclosporine. Some patients will need to stop the medication due to kidney function changes.

Nausea and/or Vomiting

Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Diarrhea

Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange and grapefruit sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.

Taste and smell changes

You may experience a metallic taste or dislike foods or beverages that you liked before receiving chemotherapy. These symptoms can last up to several months. Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell. Flavor meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary. Bacon, ham and onion can add flavor to vegetables. Ask your nurse about nutritional counseling services.


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