Adult Dosing
Transplant rejection prophylaxis
- Start 5-6 mg/kg/day IV; give first dose 4-12 hrs prior to transplant or postop
- Continue until the patient can tolerate the soft gelatin capsules or oral solution
- Adjust dose based on target levels, rejection status, adverse effects
- Note: IV dose=1/3 rd of PO dose
Pediatric Dosing
Transplant rejection prophylaxis (Not FDA approved)
- Start 5-6 mg/kg/day IV; give first dose 4-12 hrs prior to transplant or postop
- Continue until the patient can tolerate the soft gelatin capsules or oral solution
- Adjust dose based on target levels, rejection status, adverse effects
- Note: IV dose=1/3 rd of PO dose
[Outline]
- Cyclosporine increases risk for development of lymphomas and other malignancies. The increased risk appears related to the intensity and duration of immunosuppression. It should not be administered with other immunosuppressive agents except adrenal corticosteroids
- There have been reports of convulsions in adult and pediatric patients receiving cyclosporine
- There have been post-marketing reports of encephalopathy, including posterior reversible encephalopathy syndrome (PRES) in patients receiving cyclosporine in combination with high dose methylprednisolone . Manifestations include impaired consciousness, convulsions, visual disturbances (including blindness), loss of motor function, movement disorders and psychiatric disturbances
- Cyclosporine), when used in high doses, can cause hepatotoxicity and nephrotoxicity. Monitor kidney function; dose dependent increases in serum creatinine and urea during first few weeks may necessitate dose reduction in transplant patients
- Implement infection control measures if WBC drops. Implement bleeding precautions if platelet count drops
- Cyclosporine should not be given to pregnant or lactating women unless benefits outweigh risks
- Monitor cyclosporine blood concentrations closely
- Monitor patients closely when switching from modified to non modified formulations
- RA patients: Monitor BUN/creatinine and at least 2 BP measurements at baseline, then q2 wks x 3 months, then qmo. Monitor BP and creatinine after a NSAID dose increase or initiation of a new NSAID during treatment. If patient also receives methotrexate, evaluate CBC and liver function before starting therapy and monthly during treatment
- Psoriasis patients: Monitor BUN/creatinine and at least 2 BP measurements at baseline, then q2 wks x 3 months, then qmo or when starting or increasing NSAID dose. Monitor CBC, K, Mg, lipid panel, uric acid at baseline, then q2wk x3 months, then qmo or more frequently if adjusting dose. Monitor LFTs
- Transplant patients: Monitor BUN/Cr at baseline, then frequently. Monitor LFTs, K, Mg, lipid panel and serum drug levels
- Monitor blood pressure (discontinue if hypertension develops that cannot be controlled by antihypertensives)
- Avoid excess UV light exposure
- Avoid live attenuated vaccines
- Closely monitor renal function (particularly serum creatinine) in patients concomitantly receiving any drug with cyclosporine which may result in additive or synergistic renal impairment
- Caution should be exercised while administering cyclosporine to pregnant/nursing women, alcoholics, patients with epilepsy or liver disease, alcoholics, and children due to its alcohol content
Cautions: Use Cautiously in
- Hepatic impairment
- Renal impairment
- Concurrent nephrotoxic agent use
- Malabsorption syndromes
- Co-administration of ACE inhibitors
- Elderly patients
Breastfeeding: Safety unknown. Cyclosporine concentration in milk is variable. Limited information indicates that cyclosporine produces low levels in breastmilk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 16 july 2010). Manufacturer advises a decision to be made whether to discontinue nursing or to discontinue the drug after considering maternal importance of therapy. Ethanol is present in breast milk, and may be orally absorbed by a nursing infant.
Pricing data from www.DrugStore.com in U.S.A.
- SandIMMUNE 50 MG/ML SOLN [Ampule] (NOVARTIS)
5 ml = $45.99
15 ml = $123.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.