Brand
name: PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune)
Pronounced: SAN-dim-ewn
Generic name: Cyclosporine
Other brand name: Neoral
Why is PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) prescribed?
PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) is given after organ transplant surgery to help prevent
rejection of organs (kidney, heart, or liver) by holding down the body's
immune system. It is also used to avoid long-term rejection in people
previously treated with other immunosuppressant drugs, such as Imuran.
Neoral is a newer formulation of PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune)'s active ingredient, cyclosporine.
In addition to prevention of organ rejection, it is prescribed for
certain severe cases of rheumatoid arthritis and psoriasis.
Some doctors also prescribe PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) to treat alopecia areata (localized
areas of hair loss), aplastic anemia (shortage of red and white blood
cells and platelets), Crohn's disease (chronic inflammation of the
digestive tract), and nephropathy (kidney disease). PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) is sometimes
used in the treatment of severe skin disorders, including psoriasis
and dermatomyositis (inflammation of the skin and muscles causing weakness
and rash). The drug is also used in procedures involving bone marrow,
the pancreas, and the lungs.
PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) is always given with prednisone or a similar steroid. It
is available in capsules and liquid, or as an injection.
Most important fact about PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune)
If you take PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) orally over a period of time, your doctor will
monitor your blood levels of cyclosporine to make sure your body is
receiving the correct amount of PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune). The reason for this repeated
testing is that the absorption of PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) in the body is erratic.
Constant monitoring is necessary to prevent toxicity due to overdosing
or to prevent possible organ rejection due to underdosing. It is important
to note that PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) may need to be taken by mouth for an indefinite
period following surgery.
How should you take PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune)?
Take the PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) capsule or oral liquid at the same time every
day. You may take PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) either with a meal or between meals, but
be consistent.
To make PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) oral liquid more palatable, you may mix it with
room-temperature milk, chocolate milk, or orange juice. Try to use
the same beverage as often as possible. Neoral oral solution may be
mixed with room-temperature orange or apple juice. It does not taste
good in milk. Use a container made of glass, not plastic. Never let
the mixture stand; drink it as soon as you prepare it. To make sure
you get your full dose, rinse the glass with a little more liquid and
drink that too.
You should maintain good dental hygiene and see your dentist frequently
for cleaning to prevent tenderness, bleeding, and gum enlargement.
After you use the dosage syringe to transfer the oral solution to
a glass, dry the outside of the syringe with a clean towel and put
it away. Do not rinse or wash it. If you do have to clean it, make
sure it is thoroughly dry before you use it again.
You may notice an odor when you open the capsule container; this is
nothing to worry about and will soon dissipate.
Neoral should start to work on rheumatoid arthritis in 4 to 8 weeks,
and on psoriasis in 2 weeks. Psoriasis is usually controlled within
12 to 16 weeks; you should not take the drug for more than a year.
If you miss a dose...
If fewer than 12 hours have passed, take it as soon as you remember.
If it is almost time for the next dose, skip the one you missed and
go back to your regular schedule. Do not take 2 doses at once.
Storage instructions...
Store both the capsules and the oral solution at room temperature.
Do not store the liquid in the refrigerator. Keep the liquid from freezing.
PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) liquid, once opened, must be used within 2 months.
PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) side effects
Side effects cannot be anticipated. If any appear or change in intensity,
inform your doctor immediately. Only your doctor can determine if it
is safe for you to continue taking PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune). The principal side effects
of PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) are high blood pressure, hirsutism (unusual growth of
hair), kidney damage, excessive growth of the gums, and tremor.
* Other side effects may include:
Abdominal discomfort, acne, breathing difficulty, convulsions, coughing, cramps,
diarrhea, flu-like symptoms, flushing, headache, liver damage, lymph system
tumor, muscle, bone, or joint pain, nasal inflammation, nausea, numbness
or tingling, sinus inflammation, vomiting, wheezing
Why should PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) not be prescribed?
Do not take these products if you have ever had an allergic reaction
to them. Avoid PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) by injection if you have ever had an allergic
reaction to an injection of the drug or you are especially sensitive
to castor oil.
Avoid taking Neoral for arthritis or psoriasis if you have a kidney
condition, high blood pressure, or cancer. While taking the drug, you
should avoid most other psoriasis treatment, including ultraviolet
light, coal tar, methotrexate, and radiation.
Special warnings about PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune)
When your immune system is suppressed by PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune), you are at increased
risk of infection and of certain malignancies, including skin cancer
and lymph system cancer.
High-dose PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) is toxic to the liver and kidneys and may cause
serious kidney damage. Because this toxicity has symptoms similar to
those of transplant rejection, you must be monitored closely. If your
body is trying hard to reject a transplanted organ, your doctor will
probably allow the rejection to occur rather than give you a very high
dose of PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune).
This drug can raise blood pressure, especially in older people. If
high blood pressure develops while you are taking Neoral for transplant
rejection, the doctor will prescribe blood pressure medication. If
it develops while you are taking the drug for arthritis or psoriasis,
the doctor may lower your dose.
PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) and Neoral are not directly interchangeable. Your doctor
may need to adjust the dosage if you switch.
Brain disorders have developed in patients taking PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune), sometimes
leading to convulsions, loss of movement, vision problems, impaired
consciousness, and psychiatric disturbances. The chance of convulsions
is greater if you are taking high doses of steroid drugs, particularly
methylprednisolone (Medrol). Brain-related disorders usually clear
up once PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) is discontinued.
Use a barrier method of contraception, such as diaphragms or condoms,
during PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) therapy. Do not use oral contraceptive pills without
your doctor's approval.
Do not try to change dosage forms without consulting your doctor.
If you take Neoral for arthritis or psoriasis, the condition will
eventually return when you stop taking the drug, generally within 1
or 2 months. Neoral treatments for psoriasis should be replaced with
other types of therapy after 1 year.
Possible food and drug interactions when taking PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune)
Avoid getting immunizations while you are taking PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune). The drug
may make vaccinations less effective or increase your risk of contracting
an illness from a live vaccine.
If taking Neoral for psoriasis, remember to avoid other psoriasis
treatments.
Avoid grapefruit and grapefruit juice while taking PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune). Also
avoid the antidepressant herb St. John's Wort. This over-the-counter
herbal remedy reduces the effect of PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) and Neoral, and can
lead to organ rejection.
If PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) is taken with certain other drugs, the effects of either
could be increased, decreased, or altered. It is especially important
to check with your doctor before combining PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) with the following:
Allopurinol (Zyloprim)
Amiodarone (Cordarone)
Amphotericin B (Fungizone, Abelcet)
Atorvastatin (Lipitor)
Bromocriptine (Parlodel)
Calcium-blocking heart and blood pressure medications such as Adalat,
Calan, Cardene, Cardizem, and Procardia
Carbamazepine (Tegretol)
Cimetidine (Tagamet)
Clarithromycin (Biaxin)
Colchicine
Danazol (Danocrine)
Diclofenac (Voltaren, Cataflam)
Digoxin (Lanoxin, Lanoxicaps)
Erythromycin (E.E.S., Erythrocin, others)
Fluconazole (Diflucan)
Fluvastatin (Lescol)
Gentamicin (Garamycin)
Indinavir (Crixivan)
Itraconazole (Sporanox)
Ketoconazole (Nizoral)
Lovastatin (Mevacor)
Melphalan (Alkeran)
Methotrexate
Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol)
Metoclopramide (Reglan)
Nafcillin (Unipen)
Nelfinavir (Viracept)
Nonsteroidal anti-inflammatory drugs such as Clinoril and Naprosyn
Octreotide (Sandostatin)
Orlistat (Xenical)
Phenobarbital
Phenytoin (Dilantin)
Potassium-sparing diuretics (Dyrenium, Midamor, Aldactone)
Pravastatin (Pravachol)
Prednisolone (Delta-Cortef, Prelone)
Quinupristin (Synercid)
Ranitidine (Zantac)
Rifampin (Rifadin, Rifamate, Rimactane)
Ritonavir (Norvir)
Saquinavir (Fortovase)
Simvastatin (Zocor)
Ticlopidine (Ticlid)
Tacrolimus (Prograf)
Tobramycin (Nebcin)
Trimethoprim/sulfamethoxazole (Bactrim, Septra)
Vancomycin (Vancocin)
Special information if you are pregnant or breastfeeding
The effects of PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune)
without a prescriptions in pregnancy have not been adequately studied.
If you are pregnant or plan to become pregnant, inform your doctor
immediately. PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune)
should be used during pregnancy only if the benefit justifies the potential
risk to the unborn child. Since PANIMUN BIORAL (Neoral, Cyclosporine,
Gengraf, Sandimmune)
appears in breast milk, it should not be used during breastfeeding.
If you are a new mother, you may need to choose between taking PANIMUN
BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune) and breastfeeding
your baby.
Recommended dosage for PANIMUN BIORAL (Neoral, Cyclosporine, Gengraf, Sandimmune)
ADULTS
Overdosage
