Gengraf Oral Solution

GENGRAF® Oral Solution
(cyclosporine) Oral Solution, USP [MODIFIED]

WARNING

Only physicians experienced in the management of systemic immunosuppressive therapy for the indicated disease should prescribe Gengraf® (cyclosporine oral solution, USP [MODIFIED]). At doses used in solid organ transplantation, only physicians experienced in immunosuppressive therapy and management of organ transplant recipients should prescribe Gengraf®. Patients receiving the drug should be managed in facilities equipped and staffed with adequate laboratory and supportive medical resources. The physician responsible for maintenance therapy should have complete information requisite for the follow-up of the patient.

Gengraf®, a systemic immunosuppressant, may increase the susceptibility to infection and the development of neoplasia. In kidney, liver, and heart transplant patients Gengraf® may be administered with other immunosuppressive agents. Increased susceptibility to infection and the possible development of lymphoma and other neoplasms may result from the increase in the degree of immunosuppression in transplant patients.

Gengraf® (cyclosporine oral solution, USP [MODIFIED]) has increased bioavailability in comparison to Sandimmune®* (cyclosporine oral solution, USP [Non-Modified]). Gengraf® and Sandimmune®* are not bioequivalent and cannot be used interchangeably without physician supervision. For a given trough concentration, cyclosporine exposure will be greater with Gengraf® than with Sandimmune®*. If a patient who is receiving exceptionally high doses of Sandimmune®* is converted to Gengraf®, particular caution should be exercised. Cyclosporine blood concentrations should be monitored in transplant and rheumatoid arthritis patients taking Gengraf® to avoid toxicity due to high concentrations. Dose adjustments should be made in transplant patients to minimize possible organ rejection due to low concentrations. Comparison of blood concentrations in the published literature with blood concentrations obtained using current assays must be done with detailed knowledge of the assay methods employed.

For Psoriasis Patients (see also BOXED WARNINGS above)

Psoriasis patients previously treated with PUVA and to a lesser extent, methotrexate or other immunosuppressive agents, UVB, coal tar, or radiation therapy, are at an increased risk of developing skin malignancies when taking Gengraf® (cyclosporine oral solution, USP [MODIFIED]).

Cyclosporine, the active ingredient in Gengraf®, in recommended dosages, can cause systemic hypertension and nephrotoxicity. The risk increases with increasing dose and duration of cyclosporine therapy. Renal dysfunction, including structural kidney damage, is a potential consequence of cyclosporine, and therefore, renal function must be monitored during therapy.

DRUG DESCRIPTION

Gengraf® (cyclosporine oral solution, USP [MODIFIED]) is a modified oral formulation of cyclosporine that forms an aqueous dispersion in an aqueous environment.

Cyclosporine, the active principle in Gengraf® Oral Solution, is a cyclic polypeptide immunosuppressant agent consisting of 11 amino acids. It is produced as a metabolite by the fungus species Aphanocladium album.

Chemically, cyclosporine is designated as [R-[R*, R*-(E)]]-cyclic-(L-alanyl-D-alanyl-N-methyl-L-leucyl-N-methyl-Lleucyl-N-methyl-L-valyl-3-hydroxy-N,4-dimethyl-L-2-amino-6-octenoyl-L-α-amino-butyryl-N-methylglycyl-N-methyl-Lleucyl-L-valyl-N-methyl-L-leucyl).

Gengraf® Oral Solution (cyclosporine oral solution, USP [MODIFIED]) is available in 50 mL bottles. Each mL contains: cyclosporine 100 mg/mL.

Inactive Ingredients: Polyoxyl 40 hydrogenated castor oil NF, propylene glycol USP, sorbitan monooleate NF.

The chemical structure for cyclosporine USP is:

 GENGRAF® (cyclosporine) Structural Formula Illustration

What are the possible side effects of cyclosporine (Gengraf, Neoral, Sandimmune)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

  • fever, sweating, chills, body aches, flu symptoms, sores in your mouth and throat, weight loss;
  • change in your mental state, problems with speech or walking, decreased vision (may start gradually and get worse quickly);
  • easy bruising or bleeding, pale skin, confusion or weakness;
  • feeling light-headed...

Read All Potential Side Effects and See Pictures of Gengraf Oral Solution »

Last reviewed on RxList: 5/7/2009
This monograph has been modified to include the generic and brand name in many instances.

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