Uses

Cyclosporine is used to prevent organ rejection in people who have received a liver, kidney, or heart transplant. It is usually taken along with other medications to allow your new organ to function normally. Cyclosporine is also used to treat severe cases of rheumatoid arthritis and plaque psoriasis. In these conditions, the body's defense system (immune system) attacks healthy tissues. Cyclosporine belongs to a class of drugs known as immunosuppressants. It works by weakening the immune system to help your body accept the new organ as if it were your own (in the case of an organ transplant) and to prevent further damage to your joints (in the case of rheumatoid arthritis) or skin (in the case of psoriasis).

Other Uses

This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

This drug may also be used to reduce the risk of rejection in other types of organ transplants (such as cornea, pancreas) or bone marrow transplant. It may also be used for other conditions that are affected by the body's immune system (such as Crohn's disease).

How To Use

Take this medication by mouth as directed by your doctor, usually twice daily. You may take this medication with or without food, but it is important to choose one way and take this medication the same way with every dose.

The dosage is based on your weight, medical condition, lab tests, and response to treatment.

Carefully measure the dose using the medicine syringe provided. Do not use a household spoon because you may not get the correct dose. To help improve the taste, you should mix the measured dose with a glass of orange or apple juice that is at room temperature. Do not switch juices often. Do not mix this medication with milk since it may cause it to have a bad taste. Make sure to use a glass cup and not a plastic cup. Drink all of the mixture right away. Do not prepare a supply in advance. To make sure you have taken all of the medication, rinse the glass with more juice, then mix and drink. Consult your pharmacist if you have any questions.

Dry the outside of the syringe after use. Do not rinse it with water. If the syringe must be cleaned, make sure that it is completely dry before using it again.

Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.

It may take up to 4 months before you get the full benefit of this drug for the treatment of rheumatoid arthritis and psoriasis.

Tell your doctor if your condition does not get better (in 4 to 8 weeks for arthritis and in 2 to 4 weeks for psoriasis) or if it gets worse.

Side Effects

See also Warning section.

Shaking, headache, dizziness, unusual growth of body hair, nausea/vomiting, diarrhea, stomach upset, or flushing may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Unusual growth and swelling of the gums may occur. Brush your teeth and floss daily to reduce this problem. See your dentist regularly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high. Your doctor may control your blood pressure with medication.

Tell your doctor right away if you have any serious side effects, including:

• signs of kidney problems (such as a change in the amount of urine)
• signs of liver disease (such as nausea/vomiting that doesn't stop, dark urine, yellowing eyes/skin, stomach/abdominal pain)
• easy bruising/bleeding
• unusual tiredness
• muscle weakness/spasms
• slow/irregular heartbeat
• numb/tingling skin
• severe leg pain

Get medical help right away if you have any very serious side effects, including:

• mental/mood changes (such as confusion, difficulty concentrating)
• vision changes
• problems with speech
• clumsiness
• loss of coordination
• weakness on one side of the body
• seizures
• chest pain

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:

• rash
• itching/swelling (especially of the face/tongue/throat)
• severe dizziness
• trouble breathing

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking cyclosporine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of:

• kidney disease
• liver disease
• high blood pressure
• cancer
• skin lesions of unknown cause
• radiation treatment (including light treatment with PUVA or UVB)
• mineral imbalance (such as low level of magnesium or high level of potassium)
• recent/current infections
• high cholesterol/triglycerides levels

This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

This medication may contain alcohol. Caution is advised if you are pregnant or breastfeeding or have liver disease, alcohol dependence, or any other condition that requires you to limit/avoid alcohol in your diet. Ask your doctor or pharmacist about using this product safely.

Cyclosporine can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.

Tell your health care professional that you are using cyclosporine before having any immunizations/vaccinations. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).

This medication may increase your risk of developing skin cancer. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Your doctor may direct you to avoid phototherapy while you use this product. Ask your doctor for details.

This product may increase your potassium levels. Before using potassium supplements or salt substitutes that contain potassium, consult your doctor or pharmacist.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be at greater risk for kidney problems or high blood pressure while using this drug.

During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby or cause other problems with the baby such as being born too early (premature) or having low birth weight. Discuss the risks and benefits with your doctor.

This medication passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

Drug Interactions

See also How to Use section.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include:

• coal tar
• orlistat
• other drugs that weaken the immune system/increase the risk of infection (such as natalizumab, rituximab, tofacitinib)
• drugs that may increase potassium levels (such as potassium supplements, certain diuretics/"water pills" including amiloride, spironolactone)
• tacrolimus

Other medications can affect the removal of cyclosporine from your body, which may affect how cyclosporine works. Examples include bosentan, mifepristone, St. John's wort, among others.

This medication can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include aliskiren, dabigatran, dronedarone, elagolix, certain statins (such as pitavastatin, simvastatin), voxilaprevir, among others.

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 9-1-1. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Notes

Do not share this medication with others.

Lab and/or medical tests (such as kidney/liver function, blood pressure, blood mineral levels, cyclosporine blood levels, complete blood count, uric acid levels, lipid levels, skin exam) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

If you have had an organ transplant, it is recommended that you attend a transplant education class or support group. Learn the symptoms of organ rejection such as a feeling of being ill, fever, pain around the transplanted organ, and signs of a failing transplanted organ (a decrease in the amount of urine with kidney transplant, yellowing of the skin/eyes with liver transplant, shortness of breath/inability to exercise with heart transplant). Get medical help right away if these symptoms of rejection occur.

Missed Dose

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Storage

Store in the original bottle at room temperature. Do not refrigerate. Do not store in the bathroom. Once the bottle has been opened, use the solution within 2 months. If stored below 68 degrees F (20 degrees C), the solution may thicken and particles may form. This does not affect the medication. If this occurs, store the solution at room temperature to allow it to warm up. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Medical Alert

Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).