7 Cyclosporine Side Effects You Should Know About

Even if you don’t take them, you probably have a few prescription medication names committed to memory. They’ve been drilled into your brain after seeing and hearing their names in television advertisements again and again for years. Cyclosporine (Sandimmune, Gengraf, Neoral), however, is likely a name that’s new to you.

It’s an older medication that’s mostly used to prevent and treat organ transplant rejections, thanks to its ability to calm the function of the immune system. It’s also used for autoimmune conditions like psoriasis and rheumatoid arthritis, as well as many off-label uses. 

But in the transplant world, cyclosporine is hotly debated. It’s widely used and effective, but can come along with some significant side effects. It also requires close monitoring and coordination with your healthcare team. If you’re taking cyclosporine, here are seven of the most common side effects to be aware of. 

Note: This article focuses on side effects of the oral and intravenous (IV) forms of cyclosporine, not the eye drop form. 

1. High blood pressure

High blood pressure is a common cyclosporine side effect. It’s reported to occur in up to half of people taking it after a kidney transplant and in most people who take it after a heart transplant. Thankfully, it’s usually mild to moderate, but higher cyclosporine doses can cause larger increases in blood pressure. 

Your healthcare team should regularly monitor your blood pressure while you’re taking this medication. If it starts to go up, you may need to make dietary changes, like decreasing your salt intake or following the DASH diet. Starting a blood pressure medicine might also be necessary, especially if you have a history of high blood pressure.

2. Kidney problems

Cyclosporine has the potential to harm your kidneys. It’s linked to both short-term and long-term kidney problems. Kidney damage is reported to occur in about 25% of people with kidney transplants, 37% of people with liver transplants, and 38% of people with heart transplants. 

Short-term kidney problems

It’s common for certain blood tests to show that your kidney function is slightly worse 2 to 3 months after a transplant. But this can happen with any cyclosporine dose and at any time. It’s usually linked with higher cyclosporine doses and is often reversible with a dose decrease.

You will likely have regular blood draws to make sure that your cyclosporine dose is safe and effective for you over time. This will help your healthcare team monitor how well your kidneys are working as well as making sure your blood levels of cyclosporine are in a safe range.

There are also steps you can take to help protect your kidney health on your own. For instance, it helps to stay adequately hydrated. Be sure to let your care team know immediately if you are unable to urinate, have lower back pain, or new swelling. These could be signs of developing kidney problems.

It’s also a good idea to avoid over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin). These medications can decrease kidney function. Have your pharmacist or healthcare team review any prescriptions, OTC medications, or supplements you take to make sure they don’t affect your kidneys. They should also review for any medications that might interact with cyclosporine. 

Long-term kidney problems

Taking cyclosporine for a long period of time could cause irreversible kidney damage. It may happen to as many as 5% to 15% of people who take cyclosporine after a transplant. This is usually a slow process that happens over many years. The damage can lead to health conditions such as chronic kidney disease or end-stage renal disease.

Any signs of decreased kidney function should be checked out by your team to prevent long-term kidney damage. They may need to make cyclosporine dose adjustments or switch you to a new medication altogether.

3. Shakiness

Tremor (shakiness) is another common side effect of cyclosporine. It can occur in up to about half of people taking it after a liver transplant, in 21% of people with kidney transplants, and 31% of people with heart transplants. 

If it happens, it tends to be mild. Shakiness rarely interferes with daily activities, and it should improve over time. However, if it’s bothersome or doesn’t go away, speak with your healthcare team to determine what the best step forward looks like. 

4. Excessive hair growth

Cyclosporine can cause two different health conditions that are connected with excessive hair growth. One is called hirsutism. It can lead to excessive hair growth in a “male” pattern — on the face, back, chest, and thighs of women. The other is called hypertrichosis, which is excessive hair growth anywhere on the body that can happen to anyone. 

Specific conditions aside, excessive hair growth is usually reversible after stopping cyclosporine. But stopping cyclosporine should be a decision made in partnership with your healthcare team. You should never stop it on your own. Other options include shaving, waxing, or laser hair removal. 

5. Gum overgrowth

Up to 1 in 3 people experience gum overgrowth while taking cyclosporine. Gum overgrowth can interfere with the ability to keep your teeth clean. It can also get in the way of chewing and eating. Gum overgrowth is usually reversible after stopping cyclosporine, but switching medications isn’t always possible.

If this happens to you, make sure to loop in your dentist. Treatment options for gum overgrowth typically include working with your dentist to maintain your dental hygiene. Surgery is another potential option, but the results are often short-lived (usually lasting for up to 12 months) and the gum overgrowth often comes back. 

6. Infection

Cyclosporine is a strong immunosuppressant. Since it weakens the strength of your immune system, it’s easier to catch an infection while you’re taking it. This risk is included in a boxed warning, which is the strongest warning the FDA can give a medication. 

If you’re taking cyclosporine, let your healthcare team know right away if you have possible symptoms of an infection. Look out for symptoms like fever, chills, and body aches. It’s also a good idea to wash your hands frequently and stay away from people who are sick. 

Speak to your healthcare team about vaccinations while taking cyclosporine. Some vaccines may not work as well. Or, you might need additional vaccines to protect you from certain preventable infections. But you shouldn’t receive live vaccines — they have a higher risk of complications in people with suppressed immune systems. 

7. Liver problems

Rare liver problems — such as liver inflammation (hepatitis), yellowing of the skin and eyes (jaundice), and liver failure — are possible while taking cyclosporine. Many people who have liver problems while taking cyclosporine often have other conditions or medications that damage the liver. So it can be hard to tell whether cyclosporine, other factors, or both are causing the problems.

As a precaution, your healthcare team will monitor for any signs of liver problems through frequent blood draws. If any laboratory results show signs of liver problems, it’s usually reversible by lowering the cyclosporine dose. Reach out to your healthcare team if you have symptoms of liver problems, including belly pain, jaundice, or dark urine. 

When to contact a healthcare provider about cyclosporine side effects

Cyclosporine is linked to a number of side effects, but certain ones require more immediate attention than others. If you experience any of these side effects, contact your healthcare provider right away:

• Abnormal heart beat

• Agitation or confusion

• Chest pain

• Chills

• Fever

• Major changes in urination, such as dark urine or decreased ability to pee

• Sudden back or belly pain

• Sudden spots on your skin (especially those that change in size or color)

• Pain while chewing/eating or inability to eat

• Shortness of breath

• Uncontrolled diarrhea, nausea, or vomiting

• Unusual bruising or bleeding

• Visual changes

• Yellowing of the skin or eyes

Another important thing to know is that there are two types of oral cyclosporine. One is called cyclosporine, modified (Neoral, Gengraf) and the other is cyclosporine, non-modified (Sandimmune). 

Your body absorbs these forms of cyclosporine differently, so they’re not equal to each other. If the manufacturer or brand of your medication gets switched, reach out to your healthcare team immediately. Switching between modified and non-modified cyclosporine often requires a dose change and more frequent blood draws. This should only be done with close supervision from your healthcare team. 

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Written by:

Rachel Feaster, PharmD, BCOP, BCPS

Rachel Feaster has over 10 years of professional experience in ambulatory, inpatient, pharmacogenomics, and oncology care. She is board certified in oncology and pharmacotherapy.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Tegan Smedley, PharmD, APh

Tegan Smedley, PharmD, APh, has 10 years of experience as a pharmacist. She has worked in a variety of settings, including retail, hospital, and ambulatory care.

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