Cyclosporine

Note: this page contains information on multiple formulations of cyclosporine.

General information

Class/mechanism: Cyclic polypeptide immunosuppressive agent that reversibly and preferentially inhibits T-lymphocytes, especially the T-helper cell. Exact mechanism unknown. Suppresses humoral immunity and cell-mediated immune reactions, including graft vs. host disease, allograft rejection, delayed hypersensitivity, experimental allergic encephalomyelitis, and Freund’s adjuvant arthritis. The Neoral formulation forms a microemulsion when present in an aqueous environment.
Please choose from the products below to find specific drug/manufacturer information:

• Cyclosporine modified (Neoral)
• Cyclosporine modified (Gengraf)
• Cyclosporine non-modified (Sandimmune)

Route: IV, PO
Extravasation: no information

• Sandimmune IV injection is administered at 1/3 the PO (oral) dose of Sandimmune soft gelatin capsules or oral solution. (Cyclosporine non-modified (Sandimmune) package insert PDF page 18)
• Cyclosporine modified (Neoral/Gengraf) has higher bioavailability than Sandimmune, and particularly close attention should be given to monitoring of dose levels when changing between Neoral/Gengraf and Sandimmune.

For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, UpToDate (courtesy of Lexicomp), or the prescribing information.

Diseases for which it is used

• Aplastic anemia
• Castleman disease
• Hemophagocytic lymphohistiocytosis
• Myelodysplastic syndrome

Patient drug information

• Cyclosporine non-modified (Sandimmune) patient drug information (UpToDate)
• Cyclosporine modified (Neoral) patient drug information (UpToDate)

History of changes in PMDA indication

• 2017-08-25: Revised indication and a new dosage for the treatment of aplastic anemia which is not severe.

Also known as

• Generic names: ciclosporin, CsA, CyA, cyclosporin, cyclosporin A
• Brand names: Sandimmune, Gengraf, Neoral