NAME OF DRUG
cyclosporine

CLASSIFICATION

Immunosuppressant

ALTERNATE NAMES

SANDIMMUNE

 INDICATIONS

• prophylaxis of organ rejection in solid organ transplantation
• prophylaxis and treatment of graft versus host disease in bone marrow transplantation

 RECONSTITUTION AND STABILITY

• stable at room temperature
• do not refrigerate, protect from freezing
• solution stable for 24 hours in glass bottles. Solutions may be prepared in PVC bags for immediate administration if infused in less than 6 hours.

 COMPATIBILITY

• compatible with D5W and normal saline only
• compatible via Y-site with 10% fat emulsion and total parenteral nutrition
• compatible via Y-site with amikacin, ampicillin, cefazolin, cefotaxime, cefuroxime, clindamycin, cotrimoxazole, erythromycin, gentamicin, magnesium sulphate, metronidazole, penicillin G, propofol, ticarcillin-clavulante, tobramycin, vancomycin
• incompatible with other drugs

 ROUTES OF ADMINISTRATION

• IV intermittent 
  • dilute in D5W or NS to a final concentration between 0.2 mg/mL and 2.5 mg/mL
  • administer over 2-6 hours; maximum rate 50mg/hour
• IV infusion - dilute as above and administer over 24 hours

DO NOT GIVE IV DIRECT

 VH & HSC ADMINISTRATION POLICY

A - Not to be administered by the direct IV route.

H - The IV infusion administration rate MUST be controlled by an automated infusion control device.

 DOSAGE

Usual:  3-5 mg/kg IV daily

IV dose is one-third the oral dose

• adjust dosage to achieve therapeutic trough levels of 150-450 ng/mL (whole blood RIA monoclonal assay)

 POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• anaphylactic reactions
• hypersensitivity reactions may occur as a result of the polyethoxylated castor oil (Cremophor EL) present in the parenteral formulation of cyclosporine

 IMPORTANT IMPLICATIONS

• dose related adverse reactions include nephrotoxicity, hepatotoxicity, hypomagnesemia, hyperkalemia, paresthesias, tremor, headache, confusion and convulsions
• adverse reactions which are NOT dose related include hypertension, gum hyperplasia, acne and hirsutism
• cyclosporine blood levels must be monitored to maximize efficacy and minimize toxicity; blood samples should be drawn immediately before the dose on an intermittent dosing schedule; blood samples may be drawn at any time during a 24 hour continuous infusion but should be drawn at the same time each day

Rev. April 2004