Cyclorine (Cyclosporine) – Potent Immunosuppressant & Autoimmune Treatment

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Cyclorine (cyclosporine) is an oral immunosuppressant used to prevent organ rejection after kidney, liver, or heart transplantation. It also treats severe psoriasis, rheumatoid arthritis unresponsive to methotrexate, and certain nephrotic syndromes, by inhibiting calcineurin and reducing T-cell activity. (Mayoclinic, DrugBank)

Brand Name: Cyclorine®

Generic Name: Cyclosporine (ciclosporin)

Drug Class: Calcineurin inhibitor immunosuppressant

Formulation: Soft gelatin capsules or oral solution (50 mg, 100 mg)

Prescription Status: Rx only

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Cyclosporine (Ciclosporin): Available under brands such as Neoral®, Gengraf®, Sandimmune®; Cyclorine® is a branded generic. (Mayoclinic, DrugBank)

Cyclosporine forms a complex with cyclophilin, inhibiting calcineurin activity. This inhibits NF‑AT dephosphorylation and reduces IL‑2 and other cytokine production, suppressing T-cell activation and immune response. (DrugBank, StatPearls)

Transplant rejection prophylaxis in kidney, heart, and liver transplants; often combined with corticosteroids and azathioprine (Mayoclinic, StatPearls)

Rheumatoid arthritis unresponsive to methotrexate (Mayoclinic)

Severe recalcitrant plaque psoriasis when other systemic therapies fail (StatPearls)

Nephrotic syndrome (e.g., focal segmental glomerulosclerosis)

Off‑label: ulcerative colitis, atopic dermatitis, graft-vs-host disease, uveitis (StatPearls, Wikipedia)

Transplant prophylaxis: Typically 5–10 mg/kg/day in two divided doses; adjust to blood trough levels

Psoriasis / RA: Start at 2.5–5 mg/kg/day, titrate to response

Capsules: Swallow whole; solution may be mixed with juice (MedlinePlus, Mayoclinic)

Monitoring: Blood levels (target depending on indication), serum creatinine, liver enzymes, lipids, blood pressure, and potassium regularly

Contraindications: Hypersensitivity to cyclosporine; live vaccines; caution in malignancy or uncontrolled infections (DrugBank, Mayoclinic)

Prescriber Experience: Should be prescribed by physicians experienced with immunosuppressive therapy (FDA label – Neoral)

Hypertension, nephrotoxicity, tremor, hirsutism, gingival hyperplasia, headaches, gastrointestinal upset, edema (MedicalNewsToday, Healthline, ClevelandClinic)

Renal dysfunction, infections (e.g., viral, polyomavirus), lymphoma or skin malignancies, liver toxicity, hyperlipidemia (MedlinePlus, RxList)

Monitor renal and liver function, blood pressure, lipids, and CBC regularly

Avoid live vaccines during therapy

Advise patients to avoid excessive sun exposure due to lymphoma risk (MedlinePlus, RxList)

Monitor in pediatric, elderly, and hepatic/renal impairment

Pregnancy Category C: use only if potential benefit justifies risk; excreted in breast milk (Healthline)

Cyclosporine has significant interactions due to CYP3A4/P-gp metabolism (MedicalNewsToday, Drugs.com, RxList)

Increase levels of cyclosporine: Calcium channel blockers (e.g., verapamil, diltiazem), azole antifungals, macrolide antibiotics, protease inhibitors

Decrease effectiveness: Rifampin, carbamazepine, St. John’s wort

Other interactions: NSAIDs (renal risk), statins (increased myopathy risk), digoxin, colchicine, lithium

Food interaction: Grapefruit juice increases blood levels (Healthline)

ATC Code: L04AD01

Therapeutic Class: Immunosuppressant, calcineurin inhibitor

Prescription Status: Rx only

Proven to reduce acute organ rejection episodes when combined with corticosteroids/azathioprine (Mayoclinic, DrugBank)

Psoriasis & RA: Effective second-line treatments when methotrexate or PUVA fail (DrugBank)

Nephrotic syndrome: Cyclosporine induces remission in steroid-resistant cases

Frequently Asked Questions (Q&A)
Q1. Why is therapeutic drug monitoring necessary?
Cyclosporine has narrow therapeutic index and variable absorption. Monitoring prevents rejection/toxicity. (Mayoclinic)

Q2. Can I take it long-term after transplant?
Yes, often lifelong to prevent chronic rejection, with regular monitoring to minimize side effects.

Q3. Does Cyclorine compromise immunity?
Yes – it suppresses T-cell function, increasing infection and malignancy risks. Regular screening is vital.

Q4. What if I miss a dose?
Take as soon as remembered; if near next dose, skip it. Do not double-dose due to toxicity risk.

Q5. What should patients avoid while taking Cyclorine?
Avoid grapefruit juice, live vaccines, excessive sun, and inform provider before starting new medications due to interactions.

Store at 20–25 °C, protected from moisture and light

Keep in tightly sealed containers

For oral solution: avoid freezing; if gelled, warm to room temperature and shake (MedlinePlus, Mayoclinic)

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