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Sandimmune

Last reviewed on RxList: 11/22/2016
Sandimmune Side Effects Center

Last reviewed on RxList 01/06/2017

Sandimmune (cyclosporine) is a cyclic polypeptide immunosuppressant agent used to prevent organ rejection after a kidney, liver, or heart transplant. Sandimmune is also used to treat severe psoriasis or severe rheumatoid arthritis. Sandimmune is available in generic form. Common side effects of Sandimmune include:

Tell your doctor if you have serious side effects of Sandimmune including:

  • fever,
  • sweating,
  • chills,
  • sores in your mouth,
  • weight loss,
  • problems speaking or walking, and
  • decreased vision.

The initial oral dose of Sandimmune is given 4-12 hours prior to transplantation as a single dose of 15 mg/kg. The single daily dose is continued postoperatively for 1-2 weeks and tapered 5% per week to a maintenance dose of 5-10 mg/kg/day. Sandimmune may interact with etoposide, lithium, methotrexate, nefazodone, repaglinide, St. John's wort, ACE inhibitors, heart or blood pressure medication, medicines used to treat ulcerative colitis, other medicines used to prevent organ transplant rejection, pain or arthritis medicines, IV antibiotics, antiviral medicines, or cancer medicine. Tell your doctor all medications and supplements you are taking. Sandimmune should be used only when prescribed during pregnancy. Cyclosporine used during pregnancy has resulted in newborns with problems such as low birth weight and being born too early (premature). Other serious problems have been reported, including death. This medication passes into breast milk. Breastfeeding is not recommended while using this drug.

Our Sandimmune (cyclosporine) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Sandimmune Consumer Information

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 or short of breath, rapid heart rate, trouble concentrating;
  • pain in the lower back or side, blood in your urine, pain or burning when you urinate;
  • urinating less than usual or not at all, rapid weight gain;
  • swelling, warmth, redness, or oozing of the skin;
  • vomiting and bloody diarrhea;
  • seizure (convulsions);
  • high potassium (slow heart rate, weak pulse, muscle weakness, tingly feeling);
  • nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or
  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, chest pain, shortness of breath, uneven heartbeats).

Less serious side effects may include:

  • swollen or painful gums;
  • mild headache;
  • stomach pain, constipation, mild diarrhea; or
  • tremors or shaking, muscle spasm, numbness or tingly feeling.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Sandimmune (Cyclosporine)

Sandimmune Professional Information

SIDE EFFECTS

The principal adverse reactions of Sandimmune (cyclosporine) therapy are renal dysfunction, tremor, hirsutism, hypertension, and gum hyperplasia.

Hypertension

Hypertension, which is usually mild to moderate, may occur in approximately 50% of patients following renal transplantation and in most cardiac transplant patients.

Glomerular Capillary Thrombosis

Glomerular capillary thrombosis has been found in patients treated with cyclosporine and may progress to graft failure. The pathologic changes resemble those seen in the hemolytic-uremic syndrome and include thrombosis of the renal microvasculature, with platelet-fibrin thrombi occluding glomerular capillaries and afferent arterioles, microangiopathic hemolytic anemia, thrombocytopenia, and decreased renal function. Similar findings have been observed when other immunosuppressives have been employed post transplantation.

Hypomagnesemia

Hypomagnesemia has been reported in some, but not all, patients exhibiting convulsions while on cyclosporine therapy. Although magnesium-depletion studies in normal subjects suggest that hypomagnesemia is associated with neurologic disorders, multiple factors, including hypertension, high-dose methylprednisolone, hypocholesterolemia, and nephrotoxicity associated with high plasma concentrations of cyclosporine appear to be related to the neurological manifestations of cyclosporine toxicity.

Clinical Studies

The following reactions occurred in 3% or greater of 892 patients involved in clinical trials of kidney, heart, and liver transplants:

Body System/ Adverse Reactions Randomized Kidney Patients All Sandiimmune (cyclosporine) Patients
Sandimmune
(N=227) %
Azathioprine
(N=228) %
Kidney
(N=705) %
Heart
(N=112) %
Liver
(N=75) %
Genitourinary
  Renal Dysfunction 32 6 25 38 37
Cardiovascular
  Hypertension 26 18 13 53 27
  Cramps 4 < 1 2 < 1 0
Skin
  Hirsutism 21 < 1 21 28 45
  Acne 6 8 2 2 1
Central Nervous System
  Tremor 12 0 21 31 55
  Convulsions 3 1 1 4 5
  Headache 2 < 1 2 15 4
Gastrointestinal
  Gum Hyperplasia 4 0 9 5 16
  Diarrhea 3 < 1 3 4 8
  Nausea/Vomiting 2 < 1 4 10 4
 Hepatotoxicity < 1 < 1 4 7 4
  Abdominal Discomfort < 1 0 < 1 7 0
Autonomic Nervous System
 Paresthesia 3 0 1 2 1
  Flushing < 1 0 4 0 4
Hematopoietic
  Leukopenia 2 19 < 1 6 0
  Lymphoma < 1 0 1 6 1
Respiratory
  Sinusitis < 1 0 4 3 7
Miscellaneous
  Gynecomastia < 1 0 < 1 4 3

The following reactions occurred in 2% or less of patients: allergic reactions, anemia, anorexia, confusion, conjunctivitis, edema, fever, brittle fingernails, gastritis, hearing loss, hiccups, hyperglycemia, muscle pain, peptic ulcer, thrombocytopenia, tinnitus.

The following reactions occurred rarely: anxiety, chest pain, constipation, depression, hair breaking, hematuria, joint pain, lethargy, mouth sores, myocardial infarction, night sweats, pancreatitis, pruritus, swallowing difficulty, tingling, upper GI bleeding, visual disturbance, weakness, weight loss.

Renal Transplant Patients in Whom Therapy Was Discontinued

Reason for Discontinuation Randomized Patients All Sandimmune Patients
Sandimmune
(N=227) %
Azathioprine
(N=228) %
(N=705) %
Renal Toxicity 5.7 0 5.4
Infection 0 0.4 0.9
Lack of Efficacy 2.6 0.9 1.4
Acute Tubular Necrosis 2.6 0 1.0
Lymphoma/Lymphoproliferative Disease 0.4 0 0.3
Hypertension 0 0 0.3
Hematological Abnormalities 0 0.4 0
Other 0 0 0.7

Sandimmune (cyclosporine) was discontinued on a temporary basis and then restarted in 18 additional patients.

Patients receiving immunosuppressive therapies, including cyclosporine and cyclosporine -containing regimens, are at increased risk of infections (viral, bacterial, fungal, parasitic). Both generalized and localized infections can occur. Pre-existing infections may also be aggravated. Fatal outcomes have been reported. (See WARNINGS)

Infectious Complications in the Randomized Renal Transplant Patients

Complication Sandimmune Treatment
(N=227) % of Complications
Standard Treatment*
(N=228) % of Complications
Septicemia 5.3 4.8
Abscesses 4.4 5.3
Systemic Fungal Infection 2.2 3.9
Local Fungal Infection 7.5 9.6
Cytomegalovirus 4.8 12.3
Other Viral Infections 15.9 18.4
Urinary Tract Infections 21.1 20.2
Wound and Skin Infections 7.0 10.1
Pneumonia 6.2 9.2
*Some patients also received ALG.

Cremophor® EL (polyoxyethylated castor oil) is known to cause hyperlipemia and electrophoretic abnormalities of lipoproteins. These effects are reversible upon discontinuation of treatment but are usually not a reason to stop treatment.

Postmarketing Experience

Hepatotoxicity

Cases of hepatotoxicity and liver injury including cholestasis, jaundice, hepatitis and liver failure; serious and/or fatal outcomes have been reported. (See WARNINGS, Hepatotoxicity)

Increased Risk of Infections

Cases of JC virus-associated progressive multifocal leukoencephalopathy (PML), sometimes fatal; and polyoma virus-associated nephropathy (PVAN), especially BK virus resulting in graft loss have been reported. (See WARNINGS, Polyoma Virus Infection)

Headache, including Migraine

Cases of migraine have been reported. In some cases, patients have been unable to continue cyclosporine, however, the final decision on treatment discontinuation should be made by the treating physician following the careful assessment of benefits versus risks.

Pain of Lower Extremities

Isolated cases of pain of lower extremities have been reported in association with cyclosporine. Pain of lower extremities has also been noted as part of Calcineurin-Inhibitor Induced Pain Syndrome (CIPS) as described in the literature.

Read the entire FDA prescribing information for Sandimmune (Cyclosporine)

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