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Take this medicine only as directed by your doctor. Do not take more or less of it and do not take it more often than your doctor ordered. The exact amount of medicine you need has been carefully worked out. Taking too much may increase the chance of side effects, while taking too little may not improve your condition.

To help you remember to take your medicine, try to get into the habit of taking it at the same time each day. This will also help cyclosporine work better by keeping a constant amount in the blood.

Absorption of this medicine may be changed if you change your diet. This medicine should be taken consistently with respect to meals. You should not change the type or amount of food you eat unless you discuss it with your health care professional. If this medicine upsets your stomach, your doctor may recommend that you take it with meals. However, check with your doctor before you decide to do this on your own.

Grapefruit and grapefruit juice may increase the effects of cyclosporine by increasing the amount of this medicine in the body. You should not eat grapefruit or drink grapefruit juice while you are taking this medicine.

This medicine is to be taken by mouth even if it comes in a dropper bottle. The amount you should take is to be measured only with the specially marked dropper provided with your prescription. The dropper should be wiped with a clean towel after it is used, and stored in its container.

To make Sandimmune taste better, mix it in a glass container with milk, chocolate milk, or orange juice (preferably at room temperature). To make Neoral taste better, mix it in a glass container with apple juice or orange juice (preferably at room temperature). Do not use a wax-lined or plastic disposable container. Stir it well, then drink it immediately. After drinking all the liquid containing the medicine, rinse the glass with a little more liquid and drink that also, to make sure you get all the medicine. Dry the dropper used to measure the cyclosporine, but do not rinse it with water.

Do not stop taking this medicine without first checking with your doctor. You may have to take medicine for the rest of your life to prevent your body from rejecting the transplant.

Dosing

The dose of cyclosporine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of cyclosporine. If your dose is different, do not change it unless your doctor tells you to do so.

The number of capsules or teaspoonfuls of oral solution that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking cyclosporine.

• For oral dosage forms (capsules, oral solution):
  • For transplant rejection:
    • Adults, teenagers, or children: Dose is based on body weight. The usual dose in the beginning is 12 to 15 milligrams (mg) per kilogram (kg) (5.5 to 6.8 mg per pound) of body weight a day. After a period of time, the dose may be decreased to 5 to 10 mg per kg (2.3 to 4.5 mg per pound) of body weight a day.
  • For rheumatoid arthritis:
    • Adults or teenagers: Dose is based on body weight. The usual dose is 2.5 to 4 mg per kg (1.1 to 1.8 mg per pound) of body weight a day.
    • Children Use and dose must be determined by your doctor.
  • For psoriasis:
    • Adults or teenagers: Dose is based on body weight. The usual dose is 2.5 to 4 mg per kg (1.1 to 1.8 mg per pound) of body weight a day.
    • Children Use and dose must be determined by your doctor.
• For injection dosage form:
  • For transplant rejection:
    • Adults, teenagers, or children: Dose is based on body weight. The usual dose is 2 to 6 mg per kg (0.9 to 2.7 mg per pound) of body weight a day.

Missed dose

If you miss a dose of cyclosporine and remember it within 12 hours, take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose, go back to your regular dosing schedule, and check with your doctor. Do not double doses.

Storage

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not store the oral solution in the refrigerator.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For cyclosporine, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to cyclosporine.

Pregnancy Studies have not been done in humans. However, some women who received cyclosporine during pregnancy delivered their babies prematurely, and some babies were smaller than average when they were born. Additionally, some babies had birth defects. It is not certain that these birth defects occurred because of the use of cyclosporine by the mothers.

Studies in rats and rabbits have shown that cyclosporine at toxic doses (2 to 5 times the human dose) causes birth defects or death of the fetus.

Breast-feeding Cyclosporine passes into breast milk. There is a chance that it could cause the same side effects in the baby that it does in people taking it. It may be necessary for you to stop breast-feeding during treatment. Be sure you have discussed the risks and benefits of the medicine with your doctor.

Children This medicine has been tested in children and, in effective doses, has not been shown to cause different side effects or problems than it does in adults.

Older adults Older people are more likely to experience some side effects (e.g., high blood pressure and kidney problems) than are younger adults.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking cyclosporine, it is especially important that your health care professional knows if you are taking any of the following:

• Amiloride (e.g., Midamor) or
• Spironolactone (e.g., Aldactone) or
• Triamterene (e.g., Dyrenium) Since both cyclosporine and these medicines increase the amount of potassium in the body, potassium levels could become too high

• Allopurinol (e.g., Zyloprim) or
• Androgens (male hormones) or
• Bromocriptine (e.g., Parlodel) or
• Cimetidine (e.g., Tagamet) or
• Clarithromycin (e.g., Biaxin) or
• Danazol (e.g., Danocrine) or
• Diltiazem (e.g., Cardizem) or
• Erythromycins (medicine for infection) or
• Estrogens (female hormones) or
• Fluconazole (e.g., Diflucan) or
• Human immunodeficiency virus (HIV) protease inhibitors (e.g., Crixivan, Fortovase, Invirase, Norvir, Viracept) or
• Itraconazole (e.g., Sporanox) or
• Ketoconazole (e.g., Nizoral) or
• Nefazodone (e.g., Serzone) or
• Nicardipine (e.g., Cardene) or
• Verapamil (e.g., Calan, Covera-HS, Isoptin, Verelan) May increase effects of cyclosporine by increasing the amount of cyclosporine in the body

• Azathioprine (e.g., Imuran) or
• Chlorambucil (e.g., Leukeran) or
• Corticosteroids (cortisone-like medicine) or
• Cyclophosphamide (e.g., Cytoxan) or
• Mercaptopurine (e.g., Purinethol) or
• Muromonab-CD3 (monoclonal antibody) (e.g., Orthoclone OKT3) There may be an increased risk of infection and cancer because both cyclosporine and these medicines decrease the body's ability to fight them

• Coal tar (e.g., Balnetar, Zetar) or
• Methoxsalen (e.g., Oxsoralen) or
• Radiation therapy or
• Trioxsalen (e.g., Trisoralen) There may be increased risk of some skin cancers

• Lovastatin (e.g., Mevacor)
• Simvastatin (e.g., Zocor) May increase the risk of muscle problems and kidney problems

• Cancer or
• Precancerous skin changes Cyclosporine can make these conditions worse

• Chickenpox (including recent exposure) or
• Herpes zoster (shingles) Risk of severe disease affecting other parts of the body

• High blood pressure Cyclosporine can cause high blood pressure

• Hyperkalemia (too much potassium in the blood) Cyclosporine can make this condition worse

• Infection Cyclosporine decreases the body's ability to fight infection

• Intestine problems Effects may be decreased because cyclosporine cannot be absorbed into the body

• Kidney disease Cyclosporine can have harmful effects on the kidney when it is taken for long periods of time

• Liver disease Effects of cyclosporine may be increased because of slower removal of the medicine from the body