Home Drug Guide Cyclosporine

Drug Guide

Generic Name

Cyclosporine

Brand Names Restasis, Sandimmune, Neoral, Restasis Multidose, Gengraf, Cequa, Verkazia, Vevye

Classification

Therapeutic: Immunosuppressant

Pharmacological: Calcineurin inhibitor

FDA Approved Indications

  • Prevention of organ rejection in transplant patients
  • Treatment of chronic dry eye disease (e.g., Restasis, Cequa)
  • Vekazia for vernal keratoconjunctivitis

Mechanism of Action

Cyclosporine inhibits calcineurin, leading to suppression of T-lymphocyte activation and cytokine production, thereby reducing immune response and inflammation.

Dosage and Administration

Adult: Varies by formulation and condition; e.g., for dry eye, 1 drop in affected eye twice daily.

Pediatric: Use depending on condition; consult specific product guidelines.

Geriatric: No specific dose adjustment required, but caution in renal or hepatic impairment.

Renal Impairment: Use with caution; dose adjustments may be necessary based on severity.

Hepatic Impairment: Use with caution; monitor liver function.

Pharmacokinetics

Absorption: Variable; influenced by formulation and site of administration.

Distribution: Widely distributed in body fluids and tissues.

Metabolism: Metabolized primarily in the liver by CYP3A4 enzymes.

Excretion: Excreted mainly via biliary (feces) with minimal renal excretion.

Half Life: Approx. 8–27 hours, depending on formulation and patient factors.

Contraindications

  • Hypersensitivity to cyclosporine or any component.
  • Active infections.

Precautions

  • Monitor for infections, renal and hepatic function; potential drug interactions; malignancy risk, especially lymphomas and skin cancers; pregnancy category C; caution in lactation.

Adverse Reactions - Common

  • Left upper quadrant pain (Less common)
  • Hypertension (Common)
  • Headache (Common)
  • Gingival hyperplasia (Common)

Adverse Reactions - Serious

  • Nephrotoxicity (Serious)
  • Hypertensive crisis (Serious)
  • Hyperkalemia (Serious)
  • Malignancies (lymphoma, skin cancers) (Serious)

Drug-Drug Interactions

  • Potent CYP3A4 inhibitors (e.g., ketoconazole, erythromycin) increase cyclosporine levels.
  • CYP3A4 inducers (e.g., rifampin) decrease levels.

Drug-Food Interactions

  • Grapefruit juice increases levels.

Drug-Herb Interactions

  • St. John’s Wort decreases cyclosporine levels.

Nursing Implications

Assessment: Monitor renal function, liver function, blood pressure, and serum drug levels.

Diagnoses:

  • Risk of infection
  • Risk for renal impairment
  • Risk for hypertension

Implementation: Administer as prescribed, monitor labs, assess for signs of toxicity or infection.

Evaluation: Adjust dose based on serum levels and clinical response.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report signs of infection, changes in vision, or symptoms of renal or hepatic dysfunction.
  • Avoid grapefruit juice and St. John’s Wort.
  • Attend regular blood tests for drug levels and organ function.

Special Considerations

Black Box Warnings:

  • Increased risk of lymphoma and other malignancies, especially of skin.
  • Potential for renal impairment.

Genetic Factors: CYP3A4 genetic polymorphisms may influence metabolism.

Lab Test Interference: May interfere with certain lab tests of renal function.

Overdose Management

Signs/Symptoms: Nausea, vomiting, tremor, kidney dysfunction, hypertension.

Treatment: Supportive care; hemodialysis generally not effective for removing cyclosporine.

Storage and Handling

Storage: Store at room temperature away from moisture and light.

Stability: Stable for specified shelf life; refer to packaging for exact stability info.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.