cyclosporine
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.
What is Cyclosporine (Sandimmune)?
What is Cyclosporine (Sandimmune) used for?
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
How Cyclosporine (Sandimmune) works
Cyclosporine (Sandimmune) is a calcineurin inhibitor, which is an immunosuppressant that lowers the activity of your immune system. You need a suppressed (lowered) immune system after receiving an organ transplant so your body doesn't reject the new organ.
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What are the side effects of Cyclosporine (Sandimmune)?
Common Side Effects
- Tremor (21-55%)
- High blood pressure (13-53%)
- Hair growth on face, chest, and back in females (21-45%)
- Kidney problems (25-38%)
Other Side Effects
- Headache
- Overgrowth of gums
- Diarrhea
- Nausea
- Vomiting
- Weakness
Serious Side Effects
- Seizures
- Serious infections: fever, cough, chills, sore throat, runny or stuffy nose, body aches
- Sudden kidney injury: feeling sick or weak, urinating less than usual, confusion, blood in urine, swelling in the legs, ankles, or feet
- Liver damage: stomach pain, nausea, vomiting, clay-colored stools, yellowing of the skin or whites of the eyes
- Nerve problems: seizures, tremors, headache, tingling sensation
- Severe allergic reaction with injection form: hives, trouble breathing, swelling in the face or throat
Source: DailyMed
More on Cyclosporine (Sandimmune) side effects
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Change in your skin, such as a new growth, a sore that doesn't heal, or a change in a mole
- Dizziness, loss of balance or coordination, confusion or trouble speaking
- Hemolytic anemia—unusual weakness or fatigue, dizziness, headache, trouble breathing, dark urine, yellowing skin or eyes
- High potassium level—muscle weakness, fast or irregular heartbeat
- Increase in blood pressure
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Pain, tingling, or numbness in the hands or feet, muscle weakness, change in vision, confusion or trouble speaking, loss of balance or coordination, trouble walking, seizures
- Unusual bruising or bleeding
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Cyclosporine (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
Pharmacist tips for Cyclosporine (Sandimmune)
Swallow cyclosporine (Sandimmune) capsules whole. Don't open, crush, or chew capsules. If you have a hard time swallowing them, ask your provider about the oral solution.
You'll need regular blood tests to make sure you're getting the right dose of cyclosporine (Sandimmune). These labs will be very frequent right after your transplant (usually once or twice a week), but should become less frequent with time.
It's very important you take your cyclosporine (Sandimmune) consistently at the same time every day. Let your transplant team know right away if you miss a dose.
Many medications can interact with and change the amount of cyclosporine (Sandimmune) in your body. Talk to your transplant provider or pharmacist before starting any medication or supplement.
Additional tips for the oral solution
The cyclosporine (Sandimmune) oral solution should come with a syringe so you can measure out the right dose. Never use household spoons because they can cause you to take the wrong dose.
To make cyclosporine (Sandimmune) oral solution taste better, put the solution in a glass of room temperature milk, chocolate milk, or orange juice (but try to be consistent each time). Mix and drink it all right away. To make sure you get the full dose, you can add more milk or juice to rinse the glass and drink the mixture.
Don't rinse the syringe with water or other cleaning agents before or after using it. This could affect your dose. If you need to clean the syringe, let it dry completely before using it again.
Store cyclosporine (Sandimmune) oral solution at room temperature. Don't put it in the fridge or freezer. Once opened, you can use it for up to 2 months. After this time, throw it away and get a refill.
Frequently asked questions about Cyclosporine (Sandimmune)
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What are the risks and warnings for Cyclosporine (Sandimmune)?
Cyclosporine (Sandimmune) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Medication absorption
The absorption of cyclosporine (Sandimmune) is hard to predict and can change over time. Your transplant team will monitor your blood levels of the medication to make sure it's within the proper range. Cyclosporine (Sandimmune) is absorbed differently than modified versions of the medication, such as Gengraf and Neoral. These forms of cyclosporine are not interchangeable, meaning you can't just switch from one to the other. Taking the wrong form of cyclosporine can lead to medication levels that are too high or too low, which can lead to side effects or transplant rejection, respectively.
Kidney damage
Risk factors: Taking other medications that can damage the kidneys | Taking medications that interact and raise the levels of cyclosporine (Sandimmune)
Cyclosporine (Sandimmune) can cause kidney damage. This is more likely to happen if the levels are too high or if you're taking other medications that interact with cyclosporine (Sandimmune). The best way to prevent this is to get your labs drawn regularly and talk with your transplant team before starting any medications. If your kidneys start to show signs of damage, your transplant provider might adjust your dose to see if it helps.
Liver problems
Risk factors: History of liver problems | Taking other medications that can damage the liver | Higher doses of cyclosporine (Sandimmune)
There have been reports of people having liver problems while taking cyclosporine (Sandimmune). It usually happens in people who already have liver problems or are taking other medication that can harm the liver. It's more likely to happen in the first month after your transplant, since this is when you're taking higher doses of cyclosporine (Sandimmune). It's important to get your labs drawn on time so your provider can monitor your medication levels and liver tests.
Possible risk of cancer
Risk factors: Taking cyclosporine (Sandimmune) long-term | Taking a higher dose of cyclosporine (Sandimmune)
Taking immunosuppressants, like cyclosporine (Sandimmune), might raise your risk of cancer, including skin cancer and lymphoma (a cancer of the immune system). Limit your exposure to sunlight and ultraviolet light, wear protective clothing, and use sunblock.
Serious infections
Risk factors: Taking other immunosuppressants
Cyclosporine (Sandimmune) can raise your risk of serious or life-threatening bacterial, fungal, and viral infections. Be sure to stay away from people who are sick. Wash your hands often. In some cases, infections can happen when an inactive virus in your body, like tuberculosis (TB) or hepatitis B virus (HBV), reactivates (makes you sick again). If you develop symptoms of fever, chills, muscle aches, change in appetite or weight loss, vomiting, or skin rash, tell your transplant provider right away.
Side effects affecting brain function, nerves, and movement
Risk factors: High blood pressure | Taking high-dose corticosteroids | Having high levels of cyclosporine in the blood | Having received a liver transplant
There have been reports of people experiencing side effects affecting brain function, nerves, and movement. Let your provider know if you notice any side effects such as seizures, loss of consciousness, or vision problems. Also, let them know if you notice any changes in your behavior or thoughts. Your provider might adjust your dose of cyclosporine (Sandimmune) to see if the symptoms go away. Usually, the symptoms can ease or lessen when the dose of cyclosporine (Sandimmune) is lowered or when treatment is stopped.
High blood pressure
Risk factors: Taking other medications that can raise blood pressure
High blood pressure is a common side effect of cyclosporine (Sandimmune). It's usually mild to moderate, but in some cases can be severe. Your provider will monitor your blood pressure closely and might prescribe blood pressure-lowering medications if needed.
Vaccines
Transplant medications like cyclosporine (Sandimmune) can change the way your immune system responds to vaccines. Avoid live vaccines while taking this medication because they can make you sick. Also be sure to stay away from people who recently got a live vaccine, because they could make you sick. Always tell your provider or pharmacist that you're taking an immunosuppressant like cyclosporine (Sandimmune) before getting vaccinated and they can let you know if it's a live vaccine or not.
Cyclosporine (Sandimmune) dosage forms
Typical dosing for Cyclosporine (Sandimmune)
Your provider will calculate the starting dose of cyclosporine (Sandimmune) based on your body weight. You usually start taking it right before your transplant.
The dose will then be adjusted according to your lab values and will usually become lower as time goes on.
The typical maintenance dose of cyclosporine (Sandimmune) ranges from 5 mg/kg to 10 mg/kg by mouth daily.
Cyclosporine (Sandimmune) is also available as an intravenous infusion (IV) for people who can't take oral capsules or solutions. Your provider will switch you over to the oral form of this medication as soon as you're able to take it.
How much does Cyclosporine (Sandimmune) cost?
Cyclosporine (Sandimmune) contraindications
Allergy to polyoxyethylated castor oil
What are alternatives to Cyclosporine (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
Prevention of kidney transplant rejection
Treatment of lymphangioleiomyomatosis (LAM)
Kidney transplant
Liver or heart transplant - generic tacrolimus capsule and brand name Prograf only
Lung transplant - brand name Prograf only
What is the latest news about Cyclosporine (Sandimmune)?
Cyclosporine (Sandimmune) images
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References
Best studies we foundCrow, S. (n.d.). What you need to know post-transplant: Common nutrient and herbal interactions. National Kidney Foundation.
Grenier, J., et al. (2006). Pomelo juice, but not cranberry juice, affects the pharmacokinetics of cyclosporine in humans. Clinical Pharmacology and Therapeutics.
Nambiar, P., et al. (2018). Infection in kidney transplantation. Contemporary Kidney Transplantation.
Nelson, J., et al. (2022). Consensus recommendations for use of maintenance immunosuppression in solid organ transplantation: Endorsed by the American College of Clinical Pharmacy, American Society of Transplantation, and the International Society for Heart and Lung Transplantation. Pharmacotherapy.
Novartis Pharmaceuticals Corporation. (2023). Sandimmune- cyclosporine capsule, liquid filled; cyclosporine injection; cyclosporine solution [package insert]. DailyMed.
Safarini, O. A., et al. (2023). Calcineurin inhibitors. StatPearls.
U.S. Food and Drug Administration. (2021). Grapefruit juice and some drugs don't mix.
Wahlberg, J., et al. (1995). Consistent absorption of cyclosporine from a microemulsion formulation assessed in stable renal transplant recipients over a one-year study period. Transplantation.
Zelaya, J. E., et al. (2022). Posterior reversible encephalopathy syndrome. StatPearls.
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