Sandimmune vs. Rapamune for Organ Transplant: Important Differences and Potential Risks.

Key takeaways

Cyclosporine (Sandimmune) and sirolimus (Rapamune) are both immunosuppressants used to prevent organ rejection, but they have some key differences. Cyclosporine is a calcineurin inhibitor, while sirolimus is a mammalian target of rapamycin (mTOR) inhibitor. Cyclosporine is used for heart, liver, and kidney transplants, whereas sirolimus is only approved for kidney transplants and a condition called lymphangioleiomyomatosis (LAM). Cyclosporine can be taken as a capsule, injection, or oral solution, while sirolimus is available as tablets and an oral solution. Both medications require regular blood tests to monitor levels and are typically taken once daily. Sirolimus is not recommended for children under 12 and can cause fertility problems, while cyclosporine has been used safely in children as young as 6 months. Both medications have generic versions available, making them more affordable.

Cyclosporine

(Sandimmune)

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Sirolimus

(Rapamune)

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Summary for Sandimmune

Prescription only

Unmodified cyclosporine (Sandimmune) belongs to a drug class called calcineurin inhibitors. It's used to prevent rejection after an organ transplant, usually along with corticosteroids. Typically, cyclosporine (Sandimmune) is taken by mouth once daily. Your provider will measure the level of cyclosporine (Sandimmune) in your blood to help determine your dose and minimize side effects. This medication is available as a brand-name version and lower-cost generic.

Indications for Sandimmune

Prevention of heart, liver, and kidney transplant rejection
Treatment of chronic (long-term) rejection in heart, liver, and kidney transplant recipients previously treated with other immunosuppressive medications

Pros and Cons for Sandimmune

Pros

Comes as a capsule, injection, and oral solution
Has been used safely in children age 6 months and older
Available as a lower-cost generic medication

Cons

Can raise blood pressure and blood sugar
Need to have regular lab draws to make sure this medication's levels are within a safe range
Interacts with grapefruit juice and a lot of medications

Common Side Effects for Sandimmune

Tremor (21-55%)
High blood pressure (13-53%)
Hair growth on face, chest, and back in females (21-45%)
Kidney problems (25-38%)

Warnings for Sandimmune

Medication absorption
Kidney damage
Liver problems
Possible risk of cancer
Serious infections
Side effects affecting brain function, nerves, and movement
High blood pressure
Vaccines

Summary for Rapamune

Prescription only

Sirolimus (Rapamune) lowers the activity of your immune system to prevent rejection after a kidney transplant. It can also help with a condition that affects your lymphatic system, which is related to your immune system. Your provider will check the levels of sirolimus (Rapamune) in your blood, and this will help guide the dosing. Sirolimus (Rapamune) is available as tablets and as an oral solution, and it's usually only taken once a day. Common side effects include changes in your lab values (e.g., more cholesterol and fat in the blood, change in kidney labs), which is another reason to get your blood checked regularly while taking this medication.