DUR: Cyclosporin - Oral Formulations
Cyclosporine is a cyclic polypeptide immunosuppressant used in allogenic transplants of the skin, heart, kidneys, pancreas, bone marrow, small intestine, liver and lungs. It is available in two different oral formulations. These formulations are not bioequivalent. Sandimmune™ is the original formulation and Neoral™ or Sangcya™ is the newer microemulsion formulation. The microemulsion formulation is described as “cyclosporine, modified.” Cyclosporine, modified (microemulsion), increases the absorption and decreases the pharmacokinetic variability of cyclosporine.
The narrow therapeutic index of cyclosporine requires close monitoring of a patient. Low cyclosporine blood concentration may result in organ rejection and high blood concentrations may result in adverse effects, including nephrotoxicity, hepatotoxicity, CNS toxicity and infections.
Because the two oral formulations of cyclosporine are not bioequivalent, it is important that a patient who is stabilized on one formulation not be dispensed the other formulation, unless the prescriber is consulted with.