Cyclosporine

What is cyclosporine?

Cyclosporine is a medicine called an immunosuppressant. An immunosuppressant lowers the body's natural immunity. It is used to prevent rejection of transplanted organs, such as the kidney, heart, and liver. It is also used to prevent and help treat graft versus host disease (GVHD) in bone marrow and stem cell transplant patients. Cyclosporine may also be used to treat other conditions.

You may hear cyclosporine called by its brand names, Neoral or Sandimmune. Cyclosporine comes in a capsule, liquid, and injectable forms.

Before giving cyclosporine to your child

• Tell your doctor if your child has ever reacted badly to cyclosporine or any other medications.

Talk with the doctor or pharmacist if your child has any of the following conditions. Precautions may need to be taken with this medication if your child has:

• infection or recent exposure to infections (such as chickenpox)
• high levels of potassium (hyperkalemia)
• high blood pressure (hypertension)
• kidney or liver problems

How should you give your child cyclosporine?

• Give your child cyclosporine exactly as your doctor or pharmacist tells you to, even if your child seems well. Talk to your child's doctor before you stop giving this medicine for any reason.
• Give your child cyclosporine at the same times every day. Doses should be 12 hours apart. Pick times that are easy for you so that you do not miss doses.
• If giving liquid cyclosporine, use the special syringe the pharmacist gave you to measure the dose. If possible, give the medication directly into your child's mouth and follow with a drink of fluid. Use the same drink (such as orange or apple juice) with each dose of cyclosporine. Do not give grapefruit or grapefruit juice while your child is taking cyclosporine.
• If needed, you may mix cyclosporine in a glass container (not plastic or paper) with a drink recommended by your doctor or pharmacist. Use the same drink each time. Stir well and have your child drink it right away. After drinking all the liquid containing the medicine, rinse the glass with a little more of the same liquid. Have your child drink this as well so that they get all the medicine.
• If cyclosporine is given by an oral syringe, wipe the syringe dry after use. Do not rinse the syringe with water.
• If giving the cyclosporine capsules, do not remove the capsule from its foil package until you are ready to give it. Capsules should be swallowed whole.
• You may give cyclosporine with some food if the medicine upsets your child's stomach. Try to keep the type of food and amount of food the same. Changes in the diet of your child may change how cyclosporine is absorbed.
• Do not switch brands of cyclosporine. Talk to your child's doctor or pharmacist first.
• Cyclosporine is also a clear liquid a nurse will give by needle into your child's vein. Your child will get this medicine in the hospital clinic or the nursing unit.

What should you do if your child misses a dose of cyclosporine?

• Give the missed dose as soon as you remember.
• If it is almost time for the next dose, skip the missed dose. Give the next dose at the regular time.
• Do not give your child two doses to make up for one missed dose.

If your child vomits a dose within 20 to 30 minutes of taking cyclosporine, repeat the dose. If it is longer than 30 minutes, do not repeat the dose but make a note that the dose was vomited.

What are the possible side effects of cyclosporine?

Your child may have some of these side effects while they take cyclosporine. Check with your child's doctor if your child continues to have any of these side effects and they do not go away or they bother your child:

• increased hair growth
• leg cramps
• trembling or shaking of hands (tremor)
  
• mild headache
• upset stomach, vomiting (throwing up), or diarrhea (loose stools)
• acne

Call your child's doctor during office hours if your child has any of these side effects:

• bleeding, tender, or enlarged gums
• unusual tiredness or weakness
• frequent urge to urinate
• unexplained nervousness
• numbness or tingling of hands, feet, or lips
• blurry vision or changes in eyesight
• yellowing of the skin or eyes
• decrease in the amount of urine being made
• skin rash

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's doctor right away or take your child to the Emergency Department if your child has any of these side effects:

• fever, chills
• cough or sore throat
• blood in urine, difficulty urinating, or pain with urination
• severe headache
• seizures
• confusion
• shortness of breath or trouble breathing
• chest pain
• fast or irregular heartbeat
• severe stomach pain
• flushing of the face and neck (with injection only)

What safety measures should you take when your child is using cyclosporine?

As cyclosporine affects your child's immune system, it increases your child's chances of getting an infection. Your child can take the following precautions to prevent infections:

• Avoid people with infections, such as a cold or the flu.
• Avoid places that are very crowded with large groups of people.
• Be careful when brushing or flossing your child's teeth.
• You/your child shouldn't touch your child's eyes or inside their nose without washing you/your child's hands first.
• Your child's nurse will review with you what to do in case of fever.

Your child may not have grapefruit juice, grapefruits, or tangelos while getting cyclosporine. This may make the cyclosporine level in your child's blood go up and increase the chance of having side effects. Read the labels (front and back) of mixed fruit juices to ensure that they do not contain grapefruit juice.

It is important that you tell your child's doctor or pharmacist if your child takes any other medications (prescription, over the counter, herbal, or natural products).

There are some medicines that should not be taken together with cyclosporine or in some cases the dose of cyclosporine or the other medicine may need to be adjusted. It is important that you tell your doctor and pharmacist if your child takes any other medications, including:

• antibiotics such as macrolides or ciprofloxacin
• cisapride
• pimozide
• calcium channel blockers such as amlodipine or diltiazem
• cholesterol medications such as atorvastatin
• antifungals
• other immunosuppressants
• antiepileptic medications such as phenytoin or carbamazepine
• HIV medications

Your child should not receive any immunizations (vaccines) without your child's doctor's approval. Your child or anyone else in your household should not get oral polio vaccine while your child is being treated with cyclosporine. Tell your child's doctor if anyone in your household has recently received oral polio vaccine. Your child should avoid contact with anyone who has recently received this vaccine. Other live vaccines that your child should not get include measles, mumps, and rubella (MMR), and chickenpox vaccine.

Brushing, careful flossing, and massaging the gums may help to prevent tender, swollen, or bleeding gums. Take your child to visit the dentist every three to six months. Ensure your dentist knows your child is receiving cyclosporine.

After your child stops receiving cyclosporine, it may still cause side effects. These delayed effects may include certain types of cancer. Check with your doctor immediately if any of the following signs occur even after cyclosporine treatment has stopped:

• yellow eyes or skin
  
• black tarry bowel movements
• blood in urine or stools
• lower back or side pain
• stomach pain
  
• cough or a hoarse voice
• unusual bleeding or bruising
• diarrhea

What other important information should you know about cyclosporine?

• Keep a list of all medications your child is on and show the list to the doctor or pharmacist.
• Do not share your child's medicine with others and do not give anyone else's medicine to your child.
• Make sure you always have enough cyclosporine to last through weekends, holidays, and vacations. Call your pharmacy at least two days before your child runs out of medicine to order refills.
• Tell the doctor or dentist that your child is taking cyclosporine before your child has any operation, even on the teeth, or an emergency treatment.
• Keep all appointments at the clinic or doctor's office so that the doctor can check your child's reaction to cyclosporine. The doctor may need to change the dose so that your child is getting the right amount. The doctor may order blood tests to check for liver or kidney problems.
• There is a chance that cyclosporine may cause birth defects if it is taken at the time of conception or if it is taken during pregnancy. If your child is sexually active, it is best that they use some kind of birth control while receiving cyclosporine. Tell the doctor right away if your child may be pregnant.
• Blood levels of cyclosporine are checked routinely. On days that your child is having a level checked, do not give the morning dose until the blood has been drawn.
• Once a container of liquid cyclosporine is opened, it should be used within two months.
• Keep cyclosporine at room temperature in a cool, dry place away from sunlight. Do not store it in the bathroom or kitchen. Do not store in the refrigerator or freeze.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
  

Keep cyclosporine out of your child's sight and reach and locked up in a safe place. If your child takes too much cyclosporine, call the Ontario Poison Centre at one of these numbers. These calls are free.

• Call 416-813-5900 if you live in Toronto.
• Call 1-800-268-9017 if you live somewhere else in Ontario.
• If you live outside of Ontario, call your local Poison Information Centre.