In April 2020, the Food and Drug Administration (FDA) requested that all forms of prescription and over-the-counter (OTC) ranitidine (Zantac) be removed from the U.S. market. They made this recommendation because unacceptable levels of NDMA, a probable carcinogen (or cancer-causing chemical), were present in some ranitidine products. People taking prescription ranitidine should talk with their doctor about safe alternative options before stopping the drug. People taking OTC ranitidine should stop taking the drug and talk with their healthcare provider about alternative options. Instead of taking unused ranitidine products to a drug take-back site, a person should dispose of them according to the product’s instructions or by following the FDA’s guidance.
Cyclosporine is a drug that suppresses immune system function. Doctors prescribe it for the treatment of autoimmune conditions, including rheumatoid arthritis and psoriasis, and to prevent organ rejection after a transplant.
Although usually effective, cyclosporine can cause a range of side effects. People can work with their doctor to determine whether or not cyclosporine is the right treatment option for them.
In this article, learn more about cyclosporine, including its uses, dosage recommendations, side effects, warnings, and potential interactions with other drugs.
Cyclosporine is a prescription medication that doctors use to treat autoimmune conditions such as RA and psoriasis. It comes in many forms, including oral capsules, an oral solution, and eye drops.
Doctors also use cyclosporine to help prevent the body from rejecting an organ after a solid organ transplant.
Autoimmune conditions develop when the immune system mistakenly attacks healthy cells. Cyclosporine works by suppressing the immune system’s responses. By reducing the immune response, cyclosporine prevents the immune system from attacking healthy tissues. In the same way, it prevents the body from treating a transplanted organ as foreign matter.
Brand name versions of cyclosporine include:
The immune system’s function is to fight off disease. Drugs that suppress the immune system, called immunosuppressive drugs, can make people more likely to get infections.
Cyclosporine inhibits immune system function. Specifically, it temporarily reduces the activity of cells in the immune system called lymphocytes, such as T helper cells and T suppressor cells.
Cyclosporine also reduces how much enzyme interleukin-2 (IL-2) the body produces. IL-2 regulates white blood cell activity. Suppressing IL-2 can reduce the body’s immune response, which reduces the symptoms of autoimmune conditions.
Cyclosporine comes in a variety of forms and dosages. People should work with their doctor to determine the best treatment option for their specific needs.
Cyclosporine is available in an original form and a modified form that improves how well the body absorbs the medication. As with all others, people should take this medication in accordance with their doctor’s instructions.
People can take cyclosporine capsules (modified) or cyclosporine oral solution (modified) daily to help treat RA and psoriasis. The initial dosage is 2.5 milligrams per kilogram (mg/kg) of body weight per day, divided into two dosages. A doctor might increase this over time if needed, up to a maximum of 4 mg/kg per day.
The initial dosage of cyclosporine for an organ transplant depends on the organ and any other medications a person is taking. People tend to continue taking cyclosporine for several weeks after the transplant.
People with existing conditions that affect their kidneys or liver can take smaller dosages of cyclosporine. This is because cyclosporine can cause or worsen kidney and liver issues.
Those who take two dosages daily should try to stick to a regular schedule. If they miss a dosage, they should take it as soon as they remember. It is important not double up on dosages to make up for a missed one. This is because taking too much cyclosporine can result in adverse side effects.
Doctors may adjust the dosage for people with medical conditions that affect how well the body absorbs cyclosporine. These conditions can include:
Cyclosporine can cause a variety of side effects, such as:
- high blood pressure
- decreased kidney function
- excess hair growth in certain areas
- skin sensitivity
- stomach pain
- increased gum size
- muscle, bone, or joint pain
Symptoms of a cyclosporine overdose include:
- rapid heart rate, or tachycardia
- jaundice, a yellowing of the skin and whites of the eyes that may indicate liver damage
- kidney damage
- swelling of the arms, hands, legs, feet, or ankles
People who think they may have taken too much cyclosporine or are experiencing symptoms of an overdose should seek immediate medical attention or call Poison Control on 1-800-222-1222.
Although cyclosporine is a Food and Drug Administration (FDA)-approved drug, in some cases, it can cause severe side effects.
The National Psoriasis Foundation recommend that people avoid taking cyclosporine if they have:
- a weakened immune system
- decreased kidney function
- high blood pressure
- current cancer or a history of it
As above, cyclosporine reduces the immune system’s function. This can increase a person’s risk of developing severe infections.
People who take immunosuppressants may have a higher risk of opportunistic infections, such as polyoma viral infections, which can have serious, and sometimes fatal, outcomes.
The oral solution of cyclosporine contains a small amount of alcohol, which can negatively affect certain people.
Those who should not take the oral cyclosporine solution include children, pregnant women and those who are breastfeeding, and people who have liver disease or epilepsy.
Cyclosporine can also reduce the effectiveness of vaccines. For this reason, people may wish to consult their doctor if they plan on getting a vaccination at the same time as taking this medication.
The National Psoriasis Foundation also warn against the use of cyclosporine in people currently undergoing radiation treatment.
Cyclosporine can affect kidney function when a person takes it alongside the following drugs:
- antibiotics, such as gentamicin, tobramycin, and ciprofloxacin
- antineoplastics, such as melphalan
- antifungals, such as amphotericin B and ketoconazole
- anti-inflammatory drugs, such as colchicine and diclofenac
- gastrointestinal medications, such as cimetidine
- immunosuppressives, such as tacrolimus and methotrexate
The following medications can increase cyclosporine concentrations in the blood:
- calcium channel blockers, such as diltiazem, nicardipine, and verapamil
- antifungals, such as fluconazole, ketoconazole, and voriconazole
- antibiotics, such as clarithromycin, erythromycin, and azithromycin
- glucocorticoids, such as methylprednisolone
- oral contraceptives
People should inform their doctor if they are currently taking any medications that might interact with cyclosporine.
People should also consult their doctor or another healthcare provider before taking any natural supplements, especially St. John’s wort.
Although cyclosporine can help relieve the symptoms of arthritis, methotrexate remains the first-line treatment for RA. Both treatments offer substantial benefits and side effects, however.
For example, methotrexate can cause skin reactions in people who spend a lot of time in the sun. It may also lead to birth defects if women take it just before or during pregnancy.
Neoral, which is a form of cyclosporine, does not affect blood sugar levels. However, public health authorities do not yet consider it safe for use during pregnancy.
That said, pregnant woman can take this medication if the potential benefit to the woman “justifies the potential risk to the fetus.”
Neoral can also cause high blood pressure and kidney damage. People who take Neoral and other forms of cyclosporine may also need to take blood pressure medications.
Cyclosporine can help treat autoimmune conditions such as RA and psoriasis. It can also help prevent rejection after solid organ transplants.
Cyclosporine suppresses the immune system, which can increase people’s risk of infections.
It is best to discuss the costs and benefits of cyclosporine treatment with a doctor before beginning to use the medication.