Sandimmun Neoral (cyclosporin): Uses, uses and precautions

What is Sandimmun Neoral (cyclosporin)? What does the drug do and how is it used? What precautions should be taken while taking Sandimmun Neoral (cyclosporin)? What are the side effects of Sandimmun Neoral (cyclosporin) and how to manage it? Let's find out the role of Sandimmun Neoral through the article below by pharmacist Nguyen Ngoc Cam Tien!

Name of active ingredient : Cyclosporin.

Drugs with similar active ingredients : Sandimmun Neoral, Paolorin; Sandimmun; Sandimmun Neoral; Vilosporin;…

content

• What is Sandimmun Neoral (cyclosporin)? 
• Uses of Sandimmun Neoral (cyclosporin)
• Contraindications
• How much does Sandimmun Neoral (cyclosporin) cost?
• Dosage of Sandimmun Neoral (cyclosporin)
• How to take Sandimmun Neoral (cyclosporin)
• Things to keep in mind when taking Sandimmun Neoral (cyclosporin)
• Sandimmun Neoral (cyclosporin) side effects
• Drug interactions 
• Can pregnant and nursing women take Sandimmun Neoral (cyclosporin)?
• Can children and the elderly use Sandimmun Neoral (cyclosporin)?
• What to do in case of overdose?
• What should I do if I miss a dose of Sandimmun Neoral (cyclosporin)?
• Can I stop taking Sandimmun Neoral (cyclosporin) on my own?
• Methods of preservation 

What is Sandimmun Neoral (cyclosporin)? 

Cyclosporin is an immunosuppressive drug. Medicines are used to decrease the body's immune response.

Sandimmun Neoral (cyclosporin)

Uses of Sandimmun Neoral (cyclosporin)

• In combination with corticosteroids to prevent kidney, liver and heart transplant rejection.
• Prevention of heart-lung and pancreatic transplant rejection; Prevention of rejection after bone marrow transplantation and prevention of rejection reactions.
• Treatment of severe progressive rheumatoid arthritis with poor response to methotrexate. Cyclosporin in combination with methotrexate can be used in patients with rheumatoid arthritis that does not improve with methotrexate alone.
• In addition, the drug helps treat widespread plaque psoriasis that is disabling and difficult to treat.
• Not only that, Sandimmun Neoral also treats nephrotic syndrome caused by disease in the glomeruli.

Contraindications

Patients with hypersensitivity to cyclosporin or any of the excipients.

People with rheumatoid arthritis and people with psoriasis have decreased kidney function, uncontrolled hypertension, or malignancies.

How much does Sandimmun Neoral (cyclosporin) cost?

According to the Drug Administration of Vietnam, the declared wholesale price of 100mg Neoral Sandimmun drug at the Drug Administration of Vietnam is 73,997/tablet, which is approximately VND 3.7 million/box of Sandimmun Neoral 100mg, box of 50 tablets.

Dosage of Sandimmun Neoral (cyclosporin)

Prevention of transplant rejection

Usual starting dose:

• 10 – 15 mg/kg, orally once, 4 – 12 hours before transplantation.
• Next, 10-15 mg/kg/day for 1-2 weeks after surgery, then 5% weekly to a maintenance dose of 2-6 mg/kg/day (monitor blood levels and renal function to dose adjustment);

The dose will be lower if used concomitantly with another immunosuppressant (corticosteroid).

In people who are intolerant to oral cyclosporin, a dose of 1/3 of the oral dose can be infused intravenously, slowly over 2-6 hours or longer; The drug is diluted with 0.9% sodium chloride solution or 5% glucose solution, from 5% to a solution of 0.05 - 0.25%.

To prevent anaphylactic reactions, switch to oral as soon as possible.

Bone marrow transplantation, prevention and treatment of rejection

Initial dose intravenously 3 - 5 mg/kg/day, 1 day before transplantation, then continued for up to 2 weeks, then gradually switched to oral 12.5 mg/kg/day for 3-6 months, then gradually reduce the oral dose, can be used up to one year after transplantation (Or from the beginning of oral administration, the dose is 12.5-15 mg/kg/day).

Cyclosporin is also used by inhalation during lung transplantation.

Treatment of psoriasis

• Oral dose: starting at 2.5 mg/kg/day.
• The maximum is 4 mg. The dose is gradually reduced to the lowest effective dose.
• If there is a lack of response to the maximum dose within 6 weeks, treatment should be discontinued.

Psoriasis

Rheumatoid arthritis

• The starting oral dose is 2.5 mg/kg/day in 2 divided doses, for a period of 6 or 8 weeks.
• If clinical response is inadequate, it may be increased gradually up to a maximum of 4 mg/day.
• If there is no response after 3-4 months, treatment must be discontinued.

Nephrotic syndrome due to disease in the glomeruli

The recommended dose is divided into 2 times a day:

• In adults 5 mg/kg/day.
• In children 6 mg/kg/day when renal function is normal, except for proteinuria.

If renal impairment, initial dose ≤ 2.5 mg/kg/day. The dose should be adjusted individually, depending on proteinuria and serum creatinine, but should never exceed the recommended dose.

Maintenance dose: tapered to the lowest effective dose.

If after 3 months of treatment there is no effect, the drug must be stopped.

Note : The above dosage is for reference only. Patients need to follow the doctor's instructions for use in all cases for optimal treatment effect.

How to take Sandimmun Neoral (cyclosporin)

• The dose of cyclosporin is indicated on an individual basis; It is important to monitor cyclosporin blood or plasma concentrations to determine dose.
• Must be taken with meals and taken at a fixed time of day.
• Note, can be mixed with milk or fruit juice (do not use grapefruit juice) right before drinking to make it easier to drink.

Things to keep in mind when taking Sandimmun Neoral (cyclosporin)

• Use cyclosporin only under the supervision of an experienced physician.
• Although cyclosporin is used in combination with corticosteroids, cyclosporin should not be used concomitantly with other immunosuppressive agents because of the increased risk of infection and the risk of lymphoma.
• Risk of anaphylaxis: Intravenous infusion of cyclosporin should only be given to patients who are intolerant of oral formulations.
• During intravenous infusion of cyclosporin, respiratory support, other resuscitative measures, and drugs to treat anaphylaxis should be readily available.
• When necessary (variable oral absorption), dose adjustment should be made to avoid toxicity due to high blood or plasma concentrations or to prevent possible graft rejection due to low drug concentrations. .
• Monitoring of cyclosporin blood or plasma concentrations is especially important in allogeneic liver transplant recipients, as absorption of the drug in these individuals can be erratic.

Sandimmun Neoral (cyclosporin) side effects

• Nephrotoxicity is the most common and most important side effect of cyclosporin administration.
• Hypertension.
• Hairy, fish eggs .
• Abdominal discomfort, nausea, vomiting.
• Tremor, leg muscle spasticity (nerve - muscle and bone).
• Convulsions, headache.
• Tachycardia, feeling warm, flushed.
• Hyperkalemia, hypomagnesaemia, hyperuricemia.
• Pancreatitis.
• Liver toxicity.
• Myositis, paresthesia.
• Respiratory failure, sinusitis.
• Anaphylaxis, increased risk of infection, and sensitivity to temperatures that are too high or too low.

Drug interactions 

• Carbamazepine, Phenobarbital, Phenytoin;
• Rifampin, Isoniazid;
• Clarithromycin ;
• Diltiazem, Nicardipine, Verapamil;
• Fluconazole, Itraconazole, Ketoconazole;
• Erythromycin , Aminoglycoside, Amphotericin B, Acyclovir. 

Can pregnant and nursing women take Sandimmun Neoral (cyclosporin)?

Pregnant women

• Cyclosporin crosses the placenta.
• There is still insufficient evidence for the safety of cyclosporin in pregnant women.
• Cyclosporin should be used during pregnancy only unless the expected benefit
  outweighs the possible risk to the fetus.

Breastfeeding Women

• Cyclosporin can be distributed in breast milk.
• Because of the potential for serious adverse effects on a nursing infant, avoid breastfeeding while the mother is taking cyclosporin.

Can children and the elderly use Sandimmun Neoral (cyclosporin)?

Children and adolescents

Not recommended except for the treatment of nephrotic syndrome.

Seniors (65 years and older)

The doctor should monitor the functioning of the kidneys.

If the patient is > 65 years old and has psoriasis or atopic dermatitis , Sandimmun Neoral should only be treated if the condition is particularly severe.

What to do in case of overdose?

Symptom

• The main symptoms are undesirable effects that are more common in severity.
• Transient hepatotoxic and nephrotoxic effects may occur but may resolve upon elimination or discontinuation of the drug.

To solve

• In the event of an acute oral cyclosporin overdose, the stomach must be cleared by inducing vomiting. Inducing vomiting may be beneficial for up to 2 hours after ingestion.
• If the patient is comatose, has seizures, or has lost pharyngeal reflexes, gastric lavage can be performed if means are available to prevent aspiration of gastric secretions.
• Conduct resuscitation and symptomatic treatment.
• Of note, hemodialysis does not increase the elimination of cyclosporin.
• Therefore, in the event of a cyclosporin overdose, discontinue the drug for several days or initiate cyclosporin on alternate days until the patient is stable.

Clearing the stomach by inducing vomiting in drug overdose

What should I do if I miss a dose of Sandimmun Neoral (cyclosporin)?

• If you miss a dose, take it as soon as you remember.
• However, if the missed dose is close to the next dose. Skip the missed dose, take the next dose according to your daily dosing schedule.
• Do not take a double dose to make up for a missed dose.

Can I stop taking Sandimmun Neoral (cyclosporin) on my own?

• Do not stop taking the medicine unless your doctor tells you to.
• Continue taking your medicine even if you feel well.
• Discontinuation of drug therapy may increase the risk of transplant rejection.
• If you have any questions about using this medicine, ask your doctor or pharmacist for more information.

Methods of preservation 

• Keep this medicine out of the sight and reach of children and pets.
• Do not use expired medicine.
• Store the medicine in a cool, dry place. Suitable temperature for storage is ≤ 25°C.
• Let the medicine be stored in foil. Only quit when it's time to take the medication.
• When opening the blister pack, it is normal to have a characteristic odor.
• Dispose of unused drugs properly before releasing them into the environment.

Through this article, SignsSymptomsList has helped you answer the question of what is Sandimmun Neoral medicine . Sandimmun Neoral is a special drug with immunosuppressive effects, mainly used to prevent rejection of newly transplanted organs. Cyclosporin besides its effectiveness, the toxicity of the drug is quite high, especially nephrotoxicity. Therefore, patients need to regularly visit a doctor if there are abnormal symptoms or symptoms mentioned above so that the doctor can support and handle them promptly.