Transplant Unit

Why is this drug prescribed? Cyclosporin is a potent immunosuppressive or anti-rejection drug. It suppresses the blood cells which trigger a rejection response to the transplanted organ. It is important to continue taking cyclosporin regularly to help prevent rejection of your transplanted organ.

How to take cyclosporin

The dose has been worked out especially for you . The amount taken varies between patients and depends upon the levels in your blood, how well your kidneys are working , your blood pressure and your weight. Your dose is likely to change, your doctor will inform you of any dose changes.

Remember not to take your cyclosporin on the morning of your clinic visit before your blood tests. Bring the dose with you to take after your blood test.

Cyclosporin is to be taken twice a day, at approximately the same times each day allowing an equal space of time between each dose.

The capsules should be swallowed whole with some water.

The oral solution can be diluted with cold water, orange squash or apple juice to improve the taste. Do not take the cyclosporin with grapefruit juice and do not dilute the solution in plastic cups. The measuring syringe for the oral solution should not come into contact with any liquid. If you need to clean it wipe it with a dry tissue.

What to do if you forget a dose or take too much

If you forget a dose take it as soon as you remember. If it is almost time for your next dose, miss out the forgotten dose and continue as normal. If you do miss a dose let the transplant team know.

If you accidentally take a larger dose than recommended tell your doctor immediately.

How to store cyclosporin

The capsules and oral solution should be stored at room temperature in a dry place. Keep the capsules in the blister pack until just before you take them. For example, do not take them out of the blister package to put them into a ‘dossette’ or pill box.

They should not be stored in the fridge. If the oral solution is stored in too cool a place it may become jelly like, this can be reversed by returning the solution to room temperature.

The oral solution should be used within two months of opening.

Possible side effects of cyclosporin

Cyclosporin is a very good drug, but it does have a rather alarming list of possible side-effects. Most patients do not get most of these, but the following have been reported by some patients at some time:

• Tingling and numbness in the hands and feet. This usually subsides with time.
• Trembling hands and feet and muscle cramps. These usually subside with time. Drinking orange juice or tonic water may help to alleviate any cramp pain.
• Increase growth of body hair. If necessary this can be removed by shaving, by waxing or using a cream hair remover. A cosmetic bleach may also help. Avoid electrolysis and epilators as a method of removing hair because of the risk of infection from the needles.
• Swollen or bleeding gums. Use soft toothbrushes and good oral hygiene and have regular six monthly dental check-ups.
• Metallic taste in the mouth, poor appetite and feeling sick. Taking the capsules with a drink , after some food may help. Mouthwashes may also help.
• High blood pressure (hypertension) due to fluid retention. You may be prescribed anti-hypertensive medication for your blood pressure. Also reduce salt in your diet.
• Gout. Tell your doctor if any of your joints become swollen, hot or painful.
• Cyclosporin may affect your kidney or liver function. These will be regularly monitored at the clinic.
• High potassium and cholesterol levels may occur.
• Irregular menstrual periods and slight breast enlargement may occur in females
• Headaches, confusion and fits may rarely occur.
• Increased sensitivity to changes in temperature.
• Increased risk of developing skin lesions may occur with all anti-rejection drugs. Use a sunscreen protection 15 or higher. Report any skin lesions or lumps to your doctor.
• Increased risk of developing infections may occur with all anti-rejection drugs. Report any signs of infection (eg sore throat) to your doctor.

Taking other medicines with cyclosporin

Many other drugs may interact with Neoral so always check with your doctor or pharmacist before taking any new medication. This includes remedies which you can buy over the counter. Drugs to avoid buying are:

Aspirin-containing products for pain relief. Low doses of aspirin to prevent heart disease or stroke are OK to take.

Ibuprofen (also known as Brufen) and ibuprofen containing products

Chloroquine (also known as Nivaquine, used to prevent malarial)

Cimetidine (also known as Tagamet, used to treat indigestion and heartburn)

Erythromycin

The commonly used antibiotic erythromycin should not be prescribed for you without first consulting your transplant doctors, because it interacts with cyclosporin. It is important that drugs prescribed by other medical teams do not interfere with your immunosuppression : if in doubt, please contact your transplant team for advice.

Grapefruit

It is best to avoid eating grapefruit or drinking grapefruit juice (it interferes with the level of cyclosporin in your blood).

Other names for cyclosporin

Cyclosporin is also known by the trade name Neoral, which has replace the older formulation known as Sandimmune.