Common uses of cyclosporine
Cyclosporine (also spelled cyclosporin) is a calcineurin inhibitor that suppresses T‑lymphocyte activation, reducing interleukin‑2 and other cytokines. Systemically, it is used to prevent and treat rejection in kidney, liver, and heart transplantation, often in combination with corticosteroids and other immunosuppressants. In non‑transplant settings, oral cyclosporine treats moderate‑to‑severe plaque psoriasis and active rheumatoid arthritis when patients have not responded adequately to other therapies. It is also used for certain cases of nephrotic syndrome to reduce proteinuria and preserve kidney function under specialist care.
Ophthalmic cyclosporine emulsions (for example, 0.05% and 0.09% formulations) are prescribed for chronic dry eye disease (keratoconjunctivitis sicca) to increase tear production when inflammation contributes to reduced tear quantity and quality. Unlike systemic use, topical ocular therapy acts locally on ocular surface inflammation with minimal systemic absorption.
Dosage and direction
Cyclosporine is available as non‑modified (Sandimmune) and modified microemulsion formulations (Neoral, Gengraf, and generics). These are not interchangeable on a milligram‑for‑milligram basis due to differences in absorption. If switching formulations or brands, a clinician should adjust dosing and monitor blood levels. In transplant recipients, initial oral doses commonly range from 5–10 mg/kg/day in two divided doses, then are titrated to target trough concentrations and the patient’s clinical status. For rheumatoid arthritis and psoriasis, lower doses are used (for example, 2.5–4 mg/kg/day in divided doses), balancing efficacy with safety and renal monitoring.
Administer oral cyclosporine consistently with regard to meals to reduce variability in absorption. Swallow capsules whole. For oral solution, mix in glass (not polystyrene) with room‑temperature orange or apple juice per product instructions and drink immediately; rinse the glass to ensure the full dose is consumed. Avoid grapefruit or grapefruit juice, which can markedly increase cyclosporine levels.
Ophthalmic cyclosporine is typically instilled as one drop in each affected eye twice daily, about 12 hours apart. Remove contact lenses before use and wait at least 15 minutes before reinserting lenses or using other eye drops. Benefits in dry eye often appear after several weeks; continue as directed unless a clinician advises otherwise.
Precautions and monitoring
Cyclosporine carries boxed warnings for serious infections and malignancies due to immunosuppression, as well as for hypertension and nephrotoxicity. Use the lowest effective dose and monitor regularly. Key labs include cyclosporine trough levels (for systemic therapy), serum creatinine and eGFR, liver enzymes, electrolytes (potassium and magnesium), fasting lipids, and uric acid. Blood pressure should be checked frequently, particularly after dose changes. Report reduced urine output, swelling, shortness of breath, severe fatigue, or persistent fever promptly.
Sun protection is essential. Cyclosporine increases the risk of skin cancers, especially with prior phototherapy. Use broad‑spectrum sunscreen, wear protective clothing, and avoid tanning beds. Vaccination response may be blunted; live vaccines are generally avoided during systemic immunosuppression. Discuss immunization plans before starting therapy. People with a history of malignancy, uncontrolled hypertension, or significant renal impairment require extra caution and specialist oversight.
Pregnancy and lactation require individualized risk‑benefit assessment. Cyclosporine has been used during pregnancy in transplant patients under careful monitoring, but potential risks exist; effective contraception is advised if pregnancy is not planned. Small amounts pass into breast milk—discuss feeding plans with your clinician. Older adults and those with hepatic impairment may be more susceptible to adverse effects and often need closer monitoring.
Contraindications
Do not use cyclosporine in anyone with a known hypersensitivity to cyclosporine or any component of the formulation. For psoriasis, systemic cyclosporine is contraindicated in uncontrolled hypertension, abnormal renal function, or a history of malignancy, and it should not be combined with PUVA, UVB, methotrexate, or other immunosuppressive antimetabolites due to additive toxicity. Active serious infections are a reason to defer systemic therapy until adequately treated.
For ophthalmic cyclosporine, avoid use in active ocular infections, and discontinue if severe eye pain, marked vision changes, or intense inflammation occurs; seek prompt ophthalmic evaluation. Always verify suitability if you have had prior ocular surgery or wear contact lenses.
Possible side effects
Common systemic side effects include tremor, headache, hypertension, hirsutism, and gingival hyperplasia. Gastrointestinal effects such as nausea, abdominal discomfort, and diarrhea can occur, especially early in therapy. Metabolic changes are frequent: hyperlipidemia, hyperuricemia (with gout flares), hyperkalemia, and hypomagnesemia. Many effects are dose‑related and may improve with dose adjustments.
Serious adverse reactions require urgent attention: nephrotoxicity (rising creatinine, decreased urine output), severe hypertension, opportunistic infections (fever, cough, chills), neurotoxicity (confusion, seizures, visual disturbances, posterior reversible encephalopathy syndrome), hepatotoxicity (jaundice, dark urine), and thrombotic microangiopathy. Long‑term use increases malignancy risk, particularly lymphomas and skin cancers; routine skin checks and avoidance of excessive UV exposure are vital.
Ophthalmic cyclosporine may cause temporary eye burning or stinging upon instillation, conjunctival redness, itching, or blurred vision. These are usually mild and transient. Discontinue and seek care if you develop intense ocular pain, purulent discharge, marked swelling, or signs of infection.
Drug interactions
Cyclosporine is a substrate of CYP3A4 and P‑glycoprotein. Strong inhibitors can raise cyclosporine levels and toxicity risk: macrolide antibiotics (erythromycin, clarithromycin), azole antifungals (ketoconazole, itraconazole, voriconazole, fluconazole), certain calcium channel blockers (diltiazem, verapamil), protease inhibitors, and grapefruit products. Potent inducers can lower levels and efficacy: rifampin, rifabutin, carbamazepine, phenytoin, phenobarbital, and the herbal supplement St. John’s wort. Always inform your clinician about all medicines and supplements, including over‑the‑counter products.
Additive nephrotoxicity is a major concern. Combining cyclosporine with aminoglycosides, amphotericin B, high‑dose NSAIDs, tacrolimus, or iodinated contrast increases the risk of kidney injury. Concomitant use with potassium‑sparing diuretics, ACE inhibitors, or ARBs can raise potassium levels; monitor electrolytes closely. Cyclosporine can elevate exposure to certain statins (especially simvastatin, lovastatin, and atorvastatin), increasing myopathy/rhabdomyolysis risk—lower statin doses or alternative agents may be required.
Other notable interactions include colchicine (risk of neuromyopathy), digoxin (toxicity), and oral contraceptives (possible increased levels). Vaccines may be less effective during systemic immunosuppression; live vaccines are generally avoided. For ophthalmic cyclosporine, wait at least 15 minutes between different eye drops to prevent washout and interactions with tear film dynamics.
Missed dose
If you miss an oral cyclosporine dose, take it as soon as you remember unless it is close to the next scheduled dose. Do not double up to make up for a missed dose. Resume your regular schedule. For ophthalmic drops, instill the missed dose when remembered, then continue with the next dose at the usual time. If you miss multiple doses, contact your healthcare professional for guidance.
Overdose
Signs of cyclosporine overdose may include severe tremor, confusion, vomiting, dizziness, marked hypertension, electrolyte disturbances, and worsening kidney function (reduced urine output). There is no specific antidote. Management is supportive, with close monitoring of vitals, renal function, electrolytes, and cyclosporine concentrations. Due to high protein binding, hemodialysis has limited benefit. If an overdose is suspected, contact your local poison control center or seek emergency care immediately. Do not attempt to induce vomiting unless instructed by a medical professional.
Storage
Store oral cyclosporine at room temperature, away from excessive heat and moisture, and keep the bottle tightly closed. Follow the package insert for specific instructions for capsules versus solution; do not refrigerate the microemulsion unnecessarily, and avoid storing the solution in polystyrene containers. Keep ophthalmic emulsions at recommended room temperature; do not freeze. For single‑use vials, discard any remaining contents immediately after one use. Keep all medications out of reach of children and pets.
U.S. sale and prescription policy: buy cyclosporine without prescription, legally
In the United States, cyclosporine (oral and ophthalmic) is a prescription medication. Federal and state regulations require that dispensing occurs pursuant to a valid prescription issued after an appropriate medical evaluation, with ongoing monitoring for safety. Purchasing cyclosporine from unverified sources or without clinical oversight risks counterfeit products, unsafe dosing, dangerous interactions, and legal consequences.
HealthSouth Rehabilitation Hospital of Las Vegas offers a legal and structured solution for acquiring cyclosporine without a formal pre‑existing prescription by connecting you with licensed clinicians through a compliant, telehealth‑style review. Your medical history, current medications, and necessary monitoring are assessed, a prescription is issued when appropriate, and the pharmacy dispenses accordingly. This integrated pathway features identity verification, pharmacist support, transparent pricing, and shipping only where permitted—providing convenience without compromising U.S. safety and regulatory standards.
