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Home > Drug Category > Immunosuppressive Agents > Neoral and Equivalent

Neoral Information

Neoral (Cyclosporine) is a microemulsion formulation of cyclosporine, a potent calcineurin inhibitor used primarily for its immunosuppressive properties. It is primarily used to prevent organ transplant rejection (including kidney, liver, heart, and lung transplants). It is also used to treat severe cases of autoimmune and immune-related conditions, such as rheumatoid arthritis, psoriasis, atopic dermatitis, and nephrotic syndrome. This medication is a potent immunosuppressant, meaning it suppresses the body's immune system.

Neoral is NOT bioequivalent to other cyclosporine formulations (such as Sandimmune). These products are not interchangeable. Never switch between formulations without direct, explicit instructions from your physician, as doing so can lead to dangerous changes in blood levels of the medication. Neoral works by inhibiting calcineurin, a protein. Calcineurin is involved in the activation of T cells, which are white blood cells that play a role in the immune system. By blocking calcineurin, Neoral helps to suppress the immune system and prevent it from attacking the transplanted organs or the body's own tissues and cells.

In organ transplantation, the body's immune system may recognize the new organ as a foreign invader and attempt to destroy it; Neoral helps by suppressing these T-cells so the body accepts the new organ. For nephrotic syndrome, a condition in which the kidneys leak massive amounts of protein into the urine due to damage to the filtering units (glomeruli), this medication appears to reduce inflammation and stabilize the kidney's barrier. In autoimmune conditions like rheumatoid arthritis, psoriasis, and atopic dermatitis, the immune system is essentially overactive, attacking the joints or skin cells, respectively. In these instances, cyclosporine provides relief by slowing rapid cell turnover in the skin or by reducing the destructive inflammatory process in the joints, though it is often reserved for severe cases that haven't responded to standard treatments.

Neoral Side Effects

The therapeutic window for cyclosporine is narrow, meaning the difference between a treatment dose and a toxic one is small, hence the need for caution while taking this medication. Regular Therapeutic Drug Monitoring (TDM) through blood tests is required to ensure your dosage remains safe and effective; do not skip these scheduled appointments.

Common mild side effects may include tremors, headache, dizziness, increased body hair growth, nausea, vomiting, diarrhea, stomach upset, or flushing. Contact your doctor immediately if any of these mild side effects persist or worsen.

Stop taking this medicine and contact your doctor immediately if you experience any serious side effects, including the following:
• Allergic reactions such as breathing difficulties, body itching, body rash, skin blistering, swelling of the face, mouth, tongue, lips, or throat;
• Anemia (low red blood cells) with symptoms like dizziness, pale skin, unusual tiredness;
• Clotting problems with symptoms like unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums;
• Electrolyte imbalances with symptoms like weakness, fatigue, muscle cramps, irregular heartbeat, and tingling in the hands and feet;
• Gout (too much uric acid in the blood) with symptoms like joint pain, swelling, and warmth of joints;
• High blood pressure;
• High blood sugar;
• Kidney problems with symptoms like increased urination at night, decreased urine production, and blood in the urine;
• Leukencephalopathy with symptoms like seizures, vision loss, trouble thinking clearly, and difficulty walking;
• Liver problems with symptoms like nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools;
• Pancreatitis with symptoms like abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat;
• Signs of infection such as fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness

Inform your doctor about any other side effects you notice that are not listed here.

Neoral Precautions

Do not use this medicine if you are allergic to cyclosporine or any other ingredients in Neoral. Before using this medication, ensure you inform your doctor about any medical conditions you previously or currently have, including the following:
• Active infection;
• Cancer;
• Electrolyte imbalance, such as high potassium in the blood;
• Gout;
• Hyperuricemia (high uric acid)
• High blood pressure;
• High cholesterol in the blood;
• Kidney disease;
• Liver disease;
• Seizure disorders

It is worth noting that your doctor may want to check your white blood cell count and other blood parameters during treatment with this medication to monitor its effects. This medication can increase sun sensitivity, so it's important to limit sun exposure, avoid tanning booths and sunlamps, and use sunscreen and protective clothing while outdoors. You must avoid live attenuated vaccines, such as MMR and BCG, while taking this medication. As Neoral suppresses T-cell activity, these live viruses could replicate unchecked, potentially causing the disease they were meant to prevent. Maintain meticulous brushing and flossing, and inform your dentist that you are on cyclosporine, as it can cause gingival hyperplasia (non-painful gum overgrowth). Most guidelines suggest that this medication should only be used during pregnancy if the potential benefit outweighs the risk to the fetus. It appears that cyclosporine passes into breast milk. Therefore, breastfeeding is not recommended for patients taking Neoral, as it could affect the infant's immune system or development. Caution is advised when using this medication in children and older adults. It should not be given to children for a non-transplant disease, except for the treatment of nephrotic syndrome.

Certain medications, such as macrolide antibiotics (erythromycin), antifungals (itraconazole, voriconazole), and calcium channel blockers (diltiazem, verapamil), can dangerously increase cyclosporine levels. Therefore, it is important to tell your doctor about all medications, supplements, and herbal remedies you are using before starting Neoral. Avoid grapefruit or grapefruit juice, as they significantly alter cyclosporine's metabolism.

Neoral (cyclosporine) is available in capsule and modified oral solution form. Use either formulation only as prescribed by your doctor. Your doctor will determine the appropriate form and dose based on your age and medical condition. Establish a routine of taking your dose either always with food or always on an empty stomach. Consistency is vital because food intake can significantly affect the rate and extent of the drug's absorption. Please refer to the leaflet in the medication pack for more details on using this medication. Both forms of this medication should be stored at room temperature and kept away from direct sunlight. Do not store the oral solution below 20°C, and use it within 2 months of first opening.

Do I need a prescription to order Neoral?

Yes, a prescription is required from your physician to order Neoral.