lupkynis
Lupkynis (voclosporin) helps control kidney damage caused by lupus by lowering the activity of your immune system. It should be taken together with mycophenolate (CellCept) and steroid medications. Lupkynis (voclosporin) can interact with many medications, such as diltiazem (Cardizem) and fluconazole (Diflucan), and is only available as a brand medication so it can be expensive.
What is Lupkynis (voclosporin)?
What is Lupkynis (voclosporin) used for?
- Kidney disease caused by lupus (lupus nephritis)
How Lupkynis (voclosporin) works
Lupkynis (voclosporin) is a calcineurin inhibitor—a type of immunosuppressant. It calms your immune system and lessens inflammation to protect your kidneys from damage.
Drug facts
Side effects of Lupkynis (voclosporin)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Worsening kidney function (26%)
- High blood pressure (19%)
- Diarrhea (19%)
- Headache (15%)
- Low red blood cells (anemia) (12%)
- Cough (11%)
- Urinary tract infection (10%)
- Stomach pain (7%)
- Upset stomach, heartburn (6%)
- Hairloss (alopecia) (6%)
Less Common Side Effects
- Lower belly pain
- Mouth sores
- Fatigue, tiredness
- Tremor, shakiness
- Kidney injury
- Poor appetite
Lupkynis (voclosporin) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Infection: fever and chills, fatigue, muscle aches
- Skin cancer: new growth on your skin, change in a mole, sores that don't heal
The following Lupkynis (voclosporin) 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
- Burning or tingling sensation in hands or feet
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- 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
- Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
- Sudden and severe headache, confusion, change in vision, seizures, which may be signs of posterior reversible encephalopathy syndrome (PRES)
- Tremors or shaking
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
Pros and cons of Lupkynis (voclosporin)
Pros
- Taken by mouth
- Allows you to take a lower steroid dose
- Clinical studies included participants with many different ethnicities, which helps providers know how well this medication may work for you
Cons
- Interacts with many medications, supplements, and grapefruit juice
- Raises risk of infection and certain cancers
- Can affect how your kidneys work
- Hasn't been studied in children
Pharmacist tips for Lupkynis (voclosporin)
- Lupkynis (voclosporin) should be taken twice every day, and it's best to take it every 12 hours. For example, if you take your morning dose at 9 AM every day, take your evening dose at 9 PM. Taking it consistently on a 12-hour schedule keeps the medication levels in the right range in your body.
- Swallow the capsules whole. Don’t cut, crush, or chew them.
- Take Lupkynis (voclosporin) on an empty stomach. Food can affect your body's ability to absorb the medication, which can cause it to not work as well.
- You'll want to avoid grapefruit or grapefruit juice while you're taking Lupkynis (voclosporin). Grapefruit can affect the way your body breaks down this medication and raise the risk of side effects.
- Lupkynis (voclosporin) can raise your risk of skin cancer. Make sure to use sunscreen of SPF 30 or higher and wear clothing that protects you from the sun, even on cloudy days. Avoid tanning beds and sunlamps as well, as these can raise this risk even more.
- You will need regular blood tests to make sure you're getting the right dose of medication. Make sure to keep all of your follow-up visits with your provider and complete all blood tests ordered by your medical team.
Common questions about Lupkynis (voclosporin)
If you miss your Lupkynis (voclosporin) dose, take it as soon as you remember as long as it's less than 4 hours late. If it's been more than 4 hours since your regularly scheduled dose, go ahead and skip the missed dose. Take your next dose at your regularly scheduled time. Don't double up doses.
No, it's not safe to take Lupkynis (voclosporin) if you're pregnant because it contains alcohol, which can harm your unborn baby. Although it's a small amount per capsule, any amount of alcohol can cause behavior problems and poor brain development in your unborn baby. Similarly, don't take Lupkynis (voclosporin) while you're breastfeeding. Wait at least a week until after your last Lupkynis (voclosporin) dose before you breastfeed. Also, your provider might have you take Lupkynis (voclosporin) along with mycophenolate—a medication that can cause serious harm to your unborn baby (birth defects and miscarriage). If you're pregnant or planning to become pregnant, talk with your provider before starting treatment for your lupus nephritis.
Lupkynis (voclosporin) and Benlysta (belimumab) are both used to treat lupus nephritis. They work differently to prevent further kidney damage. Another big difference is that Lupkynis (voclosporin) is a pill that you take by mouth twice a day, while Benlysta (belimumab) is an injection. With Benlysta (belimumab), you don't need to take it every day. Both medications have their pros and cons so discuss with your provider about which of these medications would be the best fit for you.
No, Lupkynis (voclosporin) is not a steroid or corticosteroid medication. It's a medication called a "calcineurin-inhibitor." Sometimes corticosteroids and calcineurin inhibitors are used together to treat lupus nephritis.
Hair loss is one of the most common side effects of Lupkynis (voclosporin). It doesn't happen to everyone, but if it does and it concerns you, talk with your healthcare provider.
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Risks and warnings for Lupkynis (voclosporin)
Lupkynis (voclosporin) 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.
Cancer
- Risk factors: Long-term use
Using immunosuppressants, like Lupkynis (voclosporin), can raise your risk of cancer, especially skin cancer. To protect your skin, limit your time in the sun and avoid tannings beds and sun lamps. If you're going to be out in the sun, wear protective clothing and use sunscreen of SPF 30 or higher. If you notice any symptoms of skin cancer, such as new growths on your skin, changes in a mole, or sores that don't heal, contact your provider.
Serious infections
- Risk factors: Taking other immunosuppressants
Lupkynis (voclosporin) can raise your risk of serious or life-threatening bacterial, fungal, and viral infections. Wash your hands regularly and keep your distance from people who are sick. In some cases, infections can happen when an inactive virus in your body, like cytomegalovirus (CMV), reactivates (makes you sick again). Contact your healthcare provider if you develop infection symptoms such as fever, night sweats, muscle aches, tiredness, sore throat, or poor appetite.
Kidney damage
- Risk factors: Taking other medications that can damage the kidneys | Taking medications that interact and raise the levels of Lupkynis (voclosporin) | Long-term use (longer than a year)
Lupkynis (voclosporin) weakens your immune system to protect your kidneys from lupus-related damage, yet in some cases the medication can cause kidney damage. It's more likely to happen if you're taking other medications cause kidney damage, or medications that interact with Lupkynis (voclosporin). Make sure you get labs drawn regularly and talk with your healthcare provider before starting any new medications. If your kidneys start to show signs of damage, your provider might adjust your dose or stop the medication.
High blood pressure and heart rhythm problems (QTc prolongation)
- *Risk factors: History of heart problems | Taking medications that interact with Lupkynis (voclosporin) *
High blood pressure is a common side effect of calcineurin inhibitors like Lupkynis (voclosporin). Make sure you monitor your blood pressure as directed. If your blood pressure becomes too high, your provider might prescribe medications to help lower your blood pressure. Lupkynis (voclosporin) can also lead to more serious heart problems, such as an irregular heart rhythm (QTc prolongation). It's more common when the medications levels are too high, so it's important to take you medication as prescribed and get your labs drawn regularly. Medications that interact with Lupkynis (voclosporin) can also raise your risk. Make sure your medical team always has a full list of your active medications and past medical history.
Confusion and neurologic issues
In rare cases, Lupkynis (voclosporin) can cause neurologic problems (affecting the brain and nerves), including seizures. Contact your provider if you develop changes in your vision, confusion, or notice a tremor in your hands. Your provider might prescribe a lower dose of Lupkynis (voclosporin).
Live vaccines
Immunosuppressant medications like Lupkynis (voclosporin) can change the way your immune system responds to vaccines. Avoid live vaccines, such as the MMR vaccine or Varivax (chickenpox) vaccine, while taking this medication because they can make you sick. Other vaccines might not work as well while you're taking Lupkynis (voclosporin). Always tell your provider or pharmacist that you're taking an immunosuppressant like Lupkynis (voclosporin) before getting vaccinated and they can let you know if it's a live vaccine or not.
Lupkynis (voclosporin) dosage
Typical dosage for Lupkynis (voclosporin)
The typical starting dose is 23.7 mg by mouth twice a day. Your provider will also prescribe mycophenolate (CellCept) and steroids (like prednisone) to take along with this medication.
If you have poor kidney function, your healthcare provider might prescribe a lower dose.
Lupkynis (voclosporin) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Lupkynis (voclosporin) will not be safe for you to take.
- Take certain medications that strongly interact with Lupkynis (voclosporin) (e.g., itraconazole, clarithromycin)
What are alternatives to Lupkynis (voclosporin)?
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