Generic Name: Neoral
What is Neoral?
Kidney function: Cyclosporine can have harmful effects on the kidney when it is taken for long periods of time. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Liver function: People taking cyclosporine may have changes in liver function that produce abnormal liver test results.
Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Your doctor will likely recommend regular liver tests while you are taking this medication. If you have severe changes in liver function, your doctor may recommend that you take a lower dose of this medication or stop taking it altogether.
If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately. Potassium levels: Cyclosporine increases the risk of high levels of potassium in your body, especially for people who have decreased kidney function.
Your doctor will monitor the amount of potassium in your blood with blood tests.
This document does not contain all possible drug interactions. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Other medications can affect the removal of cyclosporine from your body, which may affect how cyclosporine works. Examples include boceprevir, bosentan, mifepristone, St. John's wort, telaprevir, among others. This medication can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include aliskiren, dabigatran, dronedarone, certain statins such as pitavastatin, simvastatinamong others.
If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Do not share this medication with others. Keep all medical and lab appointments. Consult your doctor for more details. If it is near the time of the next dose, skip themissed dose.
How should I take Neoral?
It appears that patients receiving liver transplant are more susceptible to encephalopathy than those receiving kidney transplant. Another rare manifestation of cyclosporine-induced neurotoxicity, occurring in transplant patients more frequently than in other indications, is optic disc edema including papilloedema, with possible visual impairment, secondary to benign intracranial hypertension.
Serum creatinine improved in all but one patient after discontinuation of cyclosporine. There is a potential, as with other immunosuppressive agents, for an increase in the occurrence of malignant lymphomas with cyclosporine. It is not clear whether the risk with cyclosporine is greater than that in rheumatoid arthritis patients or in rheumatoid arthritis patients on cytotoxic treatment for this indication.
Five cases of lymphoma were detected: four in a survey of approximately 2,300 patients treated with cyclosporine for rheumatoid arthritis, and another case of lymphoma was reported in a clinical trial. Although other tumors 12 skin cancers, 24 solid tumors of diverse types, and 1 multiple myeloma were also reported in this survey, epidemiologic analyses did not support a relationship to cyclosporine other than for malignant lymphomas.
What should I avoid while taking Neoral?
Guidelines also suggest that cyclosporine be continued rather than withdrawn during long-term maintenance therapy. IV doses should be given as dilute solutions and administered by slow infusion over 2-6 hours. Renal transplant guidelines recommend a calcineurin inhibitor CNI such as cyclosporine and an antiproliferative agent plus or minus corticosteroids for initial maintenance immunosuppression.
Cyclosporine may be given as a continuous infusion during the immediate post-op period. The initial dose of cyclosporine Modifiedis 1. If significant clinical improvement is not observed after 4 weeks, the dose may be increased by 0. Once a patient is adequately controlled and appears stable, the dose of cyclosporine should be reduced to the lowest dose that maintains an adequate response plaques may not necessarily be totally cleared.
Neoral side effects
The effectiveness of cyclosporine results from specific and reversible inhibition of immunocompetent lymphocytes in the G0- and G1-phase of the cell cycle. No effects on phagocytic function changes in enzyme secretions, chemotactic migration of granulocytes, macrophage migration, carbon clearance in vivo have been detected in animals. Cyclosporine does not cause bone marrow suppression in animal models or man. The immunosuppressive activity of cyclosporine is primarily due to parent drug.
Following oral administration, absorption of cyclosporine is incomplete.
Common Neoral ide effects may include:
Olbricht C, et al.
Rifabutin is known to increase the metabolism of other drugs metabolized by the cytochrome P-450 system.
Concurrent use may significantly increase concentrations of 21-desDFZ, the active metabolite of deflazacort, resulting in an increased risk of toxicity.
Caution should be observed while co-administering ciclosporin with such drugs or concomitant use should be avoided see section 4.
Indinavir: An interaction is anticipated to occur with all anti-retroviral protease inhibitors and cyclosporine, as all protease inhibitors inhibit CYP3A4. Indomethacin: Additive decreases in renal function have been reported between cyclosporine and nonsteroidal anti-inflammatory drugs. Infliximab: The formation of CYP450 enzymes may be suppressed by increased concentrations of cytokines e. Thus, it is expected that the formation of CYP450 enzymes could be normalized during infliximab receipt.
Insulins: Cyclosporine may cause hyperglycemia.
Where can I get more information?
Pharmacokinetic interactions between microemulsion formulated cyclosporine A and diltiazem in renal transplant recipients.
Effective pre-emptive and therapeutic strategies should be employed, particularly in patients on multiple long-term immunosuppressive therapy.