Cyclosporine (Sandimmune®, Neoral®)


Cyclosporine (Sandimmune®, Neoral®) is sometimes referred to as CSA or CyA.

What Is Cyclosporine?

Cyclosporine is an immunosuppressant drug that has been used since the early 1980s to prevent organ rejection after transplantation such as a liver transplant.

Cyclosporine medication uses

Cyclosporine prevents rejection by inhibiting T lymphocyte cells, specific cells of the immune system.

Cyclosporine dosage

Cyclosporine is taken by mouth or given by injection. The oral medication is available either as a liquid or in capsule form. Liquid cyclosporine is available in 50-ml (5000-mg) bottles (100 mg is equal to 1 ml). After being opened, liquid cyclosporine remains usable for two months. Cyclosporine capsules are available in 100-mg, 50-mg, and 25-mg doses.

How to Properly Take Cyclosporine

Liquid cyclosporine can be diluted in milk, chocolate milk, or orange juice. Do not dilute in grapefruit, pineapple, or papaya juice. Use a glass container, not a Styrofoam cup. Stir the mixture well and have your child drink it immediately. After emptying the glass, add more juice or milk and have your child drink that as well, to ensure that he or she is getting the full dose. Do not rinse the measuring syringe in water.

Capsules should be swallowed whole; they can be taken with or without food. Avoid taking this medication with grapefruit, pineapple, or papaya juice.

Cyclosporine should be taken at the same time each day. If your child takes it twice daily, the doses should be 12 hours apart.

Check with your transplant coordinator if you want to change the time of your child’s dose. If you are traveling to a different time zone, contact your coordinator for advice about when your child should take his or her medicine.

Missed doses

If fewer than three hours have passed since your child missed the dose of cyclosporine, have your child take the missed dose and get back on schedule. If more than three hours have passed, call your coordinator for advice. Taking doses too close together can be dangerous and produce side effects.

If your child misses several doses of cyclosporine because of vomiting, surgery, inability to swallow, or other reasons, he or she can receive cyclosporine intravenously. Tell your coordinator if your child is having problems receiving cyclosporine. If your child needs to receive cyclosporine intravenously, your local doctor can contact your coordinator for information about the correct intravenous dose.

Cyclosporine Side Effects

Common side effects of cyclosporine include:

  • High blood pressure.
  • Increased hair growth. If this bothers your child, different methods of removing excess hair are available. Ask your doctor about the safest one for your child.
  • Swollen or inflamed gums. Tell your coordinator if your child has swollen gums. Your child may require more dental care, such as increased brushing and flossing and more frequent dental visits. This side effect usually occurs with higher doses of cyclosporine and may improve as the dose is reduced.
  • Numbness or tingling of the hands or feet. This side effect can be a sign that your child’s cyclosporine level is high. If your child’s medication is causing this side effect, the symptoms should improve as the medication dose is reduced.
  • Other common side effects are tremors, restlessness, stomach upset, nausea, cramps, diarrhea, headache, and changes in blood sugar.

Some side effects of cyclosporine are more likely to occur in pediatric patients who are taking high doses of the medication. If this is the case with your child, you do not need to report isolated symptoms, but do tell your coordinator about increases or trends relating to the following side effects:

  • Sinus drainage or runny nose. This effect should improve as the dose is reduced.
  • Hot flashes or sweating. This effect may occur several hours after each dose and will improve as the dose is reduced.
  • Elevated "kidney numbers." Your child’s creatinine and BUN will be monitored as part of irregular laboratory studies, to prevent and/or detect kidney damage. For this reason, it is important to always check with your coordinator before giving your child any new medications that could affect kidney function.
  • Increased risk of infection

Rare side effects of cyclosporine include:

  • Change in urination
  • Seizures
  • Fever
  • Sore throat
  • Unusual bleeding or bruising
  • Trouble breathing
  • Confusion
  • Blurred vision
  • Stomach pain
  • Hearing difficulty
  • Chest pain
  • Fatigue

If any of these side effects continues or becomes bothersome, inform your doctor.

Cyclosporine Drug Interactions

Many medications may affect cyclosporine absorption. For this reason, it is extremely important that you notify your transplant coordinator of any changes in your child’s medication. Do not take large doses of aspirin or nonsteroidal anti-inflammatory medications when taking cyclosporine.

Be sure to tell your doctor or pharmacist about any other prescription or over-the-counter medication your child is taking, so you can be warned of interactions and prevent them.

If it becomes necessary for your child to begin taking a medication that affects his or her cyclosporine absorption or metabolism, the transplant surgeons may change the cyclosporine dose and order more frequent blood tests to check cyclosporine levels.

Cyclosporine Storage

Store cyclosporine capsules and liquid at room temperature, away from direct sunlight. Do not refrigerate or freeze liquid cyclosporine. After a bottle of liquid cyclosporine is opened, the medication is usable for two months. Make sure to check the expiration date on the box or bottle; dispose of any unused cyclosporine after the expiration date.

Precautions for Pediatric Patients

Take cyclosporine exactly as prescribed, at the same time each day. Never stop taking this medication unless advised to do so by a transplant surgeon or your transplant coordinator.

We recommend that patients who take cyclosporine wear a medical alert bracelet or pendant (such as jewelry marketed under the name Medic Alert) that says "Taking immunosuppressant."

Cyclosporine Availability

Not all pharmacies stock cyclosporine. Call your pharmacist at least five working days before you need to fill a prescription, to make sure the medication will be available.

Learn more about other Intestine Transplant Drugs.