Immunosuppressant drugs include-
Azathioprine, Tacrolimus (FK 506 ), Mycophenolate Mofetil, Cyclosporine, Muromonab -CD3,

Interacting drugs- summary

+Cyclosporine-

Carbamazepine /phenobarbital/pheytoin/rifampin/rifabutin
 decreased half-life and blood levels, possible of transplanted organ

Sulfametazine/ trimethoprin IV 
 decreased serum levels and possible rejection of transplated organ

Diltiazem /erythromycin/fluconazole/ ketaconazole/ nicardipine
 increased half-life, blood levels and immunosuppression,possible nephrotoxicity

Imipenin -cilastin
increased blood levels and CNS toxicity

Methylprednisolone
 increased plasma levels

High dose prednisolone
  decreased blood levels
        
Metoclopropamide
  increased bioavailability and plasma levels

Amiodranone
 increase in blood concentration, possible nephrotoxicity

Danazol/ Methyl estostreone
 increased blood concentration with possible nephrotoxicity

Nicardipine
 increased through blood levels and possibly nephrotoxicity                 

Acetazolamide
 increased trough cyclosporine levels with possible toxicity
 ( nephrotoxicity ) may occur

Anaphylactic reactions, Hypertension, Anorexia, gastritis,

Peptic ulcer, hiccups, mouth sores. Allergic reactions, Anemia,

Conjuntivitis, Edema, Fever, Hearing loss, Hyperglycemia, Muscle pain

Hypersens to polyoxyethylated castor oil.

Special precautions:

Blood level monitoring, patients with malabsorption, hypertension

Prophylaxis of organ rejection in kidney.iver, and heart allogenic transplants

Overdosage-

                              Symptoms                                             

Sanimmune is slowly absorbed.                                      
Transcient hepatotoxicity/nephrotoxiciy may occur           
                                                                                       
                              Treatment  

1. Follow general supportive treatment
2. Cyclosporine is not dialyzable to a great extent, nor cleared by charcoal hemoperfusion

Missed dose-

1. If you miss a dose of this medicine, take it as soon as possible.
2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing schedule.
3. Do not double doses. 

1. To improve flavour of the oral solution, dilute with milk, juice at room temperature.
2. See your physician regularly.
3. Any change in cyclosporine formulation, should be done with physicians advise.
4. Use mechanical contrceptive measure during cyclosporine treatment. Do not use oral    
    contraceptives
5. Advise patients to take cyclosporine on a consistent schedule with regard to the time of the day
   and relation to meals.

6. Allergies- Tell your doctor if you have ever had any unusual or allergic reactions to cyclosporine or
   other related  medicines. Also tell your doctor if youn are allergic to any other substances such as
   foods, preservatives or dyes.

7. Pregnancy- studies have not been in humans. However studies in rats and rabbits have shown that
    cyclosporine   at toxic doses (2 to 5 times the human dose) causes birth defects or dath of fetus
   
8. Breast feeding-  it may be necessary to stop breast feeding during treatment. Be sure to discuus
   this with  the doctor.
       
9. Children- not reported to cause different side effects or problems in children than adults
   
10.Elderly- not expected to cause different side effects in older people tan it does in younger adults

11. Other medicines- tell your doctor if you are taking any of the following-
   
      Amiloride or  Spironolactone or Triamterene - since both cyclosporine and triamterene increase the amount of potassium in the
       body, potassium levels could become too high.
 
       Androgen or  Cimetidine or  Danazol or  Diltiazem or  Erythromycin or   Estrogens or
       Ketoconazole - may icrease effects of cyclosporine by increasing the amount of this medicine
        in the body
         
       Azathioprine or  Chlorambucil or Corticosteroids or  Cyclophosphamide or   Mercaptopurine or
       Muromonab - CD ( monoclonal body ) there may increased risk of infection and cancer because
       both  cyclosporine and these medicines decrease the bodys ability to fight  them
      
       Lovastatin - may increase the risk of kidney problems
 
12. Other medical problems- tell your doctor if you have any other medical problems-
   
      Chickenpox or   Herpes zoster -risk of severe disease affecting other parts of the body
        
      Infection- cytarabine can decrease your bodys ability to fight infection.
      Intestine problem effects may be decreased because cyclosporine cannot be absorbed in the
      body
     
      Kidney disease- cyclosporine can have harmful effects when taken for a long time
      Liver disease - effects of cyclosporine may be increased  because of slower removal from
      the body.
   

8. Missed dose-
    If you miss a dose of this medicine take it as soon as possible. However if it is almost time
     for your  next dose,  go back to your regular dosing schedule.
    Do not double doses.

Pharmacology:

Cyclosporine is a cyclic polypeptide immunosuppressant consisting of 11 amino acids. The action is based on reversible inhibition of immunocometant lymphocytes in the phase of cell cycle. It does not cause bone marrow suppression.

Pharmacokinetics:

The absorption from the GI tract is incomplete and variable. The extent of absorption is dependent on the individual patients.

Take consistently with regard to time of day and relation to meals.

Avoid Grape juice 

Pregnancy:
Safety for use during pregnancy has not been established. Use with caution.

Lactation:
Avoid nursing; cyclosporine is excrteted in breast milk.