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Cyclosporine: Brands, Price & Uses in Bangladesh
Cyclosporine is used for the following indications, classified by strength of evidence: Established/approved: Prophylaxis of organ rejection in kidney, liver, and heart transplantation and more.
About Cyclosporine
Indications of Cyclosporine
Cyclosporine is used for the following indications, classified by strength of evidence:
- Established/approved: Prophylaxis of organ rejection in kidney, liver, and heart transplantation, used in combination with corticosteroids and/or other immunosuppressants.
- Guideline-supported, second-line: Severe active rheumatoid arthritis in patients who have not responded adequately to methotrexate or other disease-modifying antirheumatic drugs; often used in combination with methotrexate.
- Guideline-supported, second-line: Severe, recalcitrant plaque psoriasis in non-immunocompromised adults who have failed at least one systemic therapy.
- Approved (ophthalmic formulation): Chronic dry eye disease (keratoconjunctivitis sicca) believed to be due to ocular inflammation, to increase tear production.
Cyclosporine is not indicated for use outside these settings without specialist evaluation.
Dosage & Administration of Cyclosporine
Dosing of Cyclosporine must be individualized based on indication, formulation, organ function, and blood concentration monitoring. Non-modified and modified (microemulsion) formulations of Cyclosporine are not bioequivalent; any conversion between formulations must be done gradually under close physician supervision with blood level monitoring.
| Indication | Typical Adult Dosing |
|---|---|
| Organ transplant rejection prophylaxis (kidney, liver, heart) | Initial dose commonly 9-15 mg/kg/day (modified formulation, in divided doses) given a few hours before transplantation and continued with corticosteroids, tapering to a maintenance dose (often 3-10 mg/kg/day) guided by trough blood levels, renal function and clinical response. |
| Severe active rheumatoid arthritis (second-line, after inadequate response to methotrexate or other disease-modifying agents) | Initial 2.5 mg/kg/day in two divided doses; may be increased gradually (by up to 0.5-0.75 mg/kg/day) at 8-week intervals to a maximum of about 4 mg/kg/day, based on efficacy and tolerability; often combined with methotrexate. |
| Severe plaque psoriasis (second-line, in immunocompetent patients who have failed at least one systemic therapy) | Initial 2.5 mg/kg/day in two divided doses; may be increased after 4 weeks by up to 0.5 mg/kg/day if response is insufficient, to a maximum of 4 mg/kg/day; treatment courses are generally kept as short as possible. |
| Chronic dry eye disease (ophthalmic emulsion) | One drop in each affected eye twice daily, approximately 12 hours apart. |
Regular monitoring of blood pressure, serum creatinine, and (for oral/systemic use) Cyclosporine trough blood concentrations is required throughout treatment to guide dose adjustments and reduce toxicity risk.
Side Effects of Cyclosporine
Common side effects of systemic Cyclosporine include:
- Kidney function impairment (nephrotoxicity) and elevated serum creatinine
- High blood pressure (hypertension)
- Tremor and headache
- Excessive hair growth (hirsutism)
- Gum overgrowth (gingival hyperplasia)
- High cholesterol/triglycerides (hyperlipidemia)
- Nausea, vomiting, diarrhea, abdominal discomfort
- Increased susceptibility to infections
- Fatigue and leg cramps
Less common but serious effects include liver dysfunction, electrolyte disturbances (e.g., high potassium, low magnesium), and - with long-term use - increased risk of malignancies such as lymphoma and skin cancer (see Precautions and Warnings).
With the ophthalmic emulsion, the most common effects are burning or stinging at the site of instillation, eye redness, discharge, watering, eye pain, and blurred vision, which are usually mild and localized.
Contraindications of Cyclosporine
Cyclosporine is contraindicated in:
- Patients with known hypersensitivity to cyclosporine or to any component of the specific formulation (including polyoxyethylated castor oil in some injectable forms).
- Concurrent use with excessive ultraviolet light exposure or PUVA (psoralen plus UVA) phototherapy, when Cyclosporine is used for psoriasis, because of markedly increased skin cancer risk.
- Simultaneous administration with tacrolimus (due to additive nephrotoxicity and lack of established safety).
For the ophthalmic emulsion, Cyclosporine is contraindicated in patients with active or suspected ocular or periocular infection.
Frequently Asked Questions about Cyclosporine
What is Cyclosporine used for?
Cyclosporine is mainly used to prevent the body from rejecting a transplanted kidney, liver, or heart, usually combined with other immunosuppressant medicines. It is also used in some patients with severe rheumatoid arthritis or severe plaque psoriasis who have not responded well to other treatments, and as an eye drop (ophthalmic emulsion) to treat chronic dry eye disease.
How should I take Cyclosporine?
Take Cyclosporine exactly as prescribed by your physician, at the same time each day, and consistently either with or without food. Do not switch between different brands or formulations of Cyclosporine without your doctor's approval, since they are not interchangeable. Avoid grapefruit or grapefruit juice, which can raise blood levels of Cyclosporine.
What are the most serious risks of Cyclosporine?
Cyclosporine can cause kidney damage, high blood pressure, and - because it suppresses the immune system - an increased risk of serious infections and certain cancers, including lymphoma and skin cancer. For this reason, Cyclosporine should only be prescribed by a physician experienced in immunosuppressive therapy, with regular blood tests and monitoring.
Can I take Cyclosporine during pregnancy or while breastfeeding?
Cyclosporine should be used in pregnancy only if clearly needed, such as to protect a transplanted organ, since it may increase the risk of preterm delivery and low birth weight; benefits and risks must be weighed by your physician. Cyclosporine passes into breast milk, and breastfeeding is generally discouraged during treatment unless your doctor advises otherwise.
What should I do if I miss a dose or take too much Cyclosporine?
If you miss a dose of Cyclosporine, take it as soon as you remember unless it is close to your next dose - do not double the dose. If you or someone else has taken too much Cyclosporine, seek immediate medical attention or contact a poison control center right away.
Can Cyclosporine be used in children?
Cyclosporine is used in children who have received an organ transplant, under specialist supervision, with doses individualized by body weight. Its use for rheumatoid arthritis, psoriasis, or dry eye disease in children has not been established as safe and effective, so it should generally be avoided for those conditions in pediatric patients.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.