Ciclosporin

(BAN, rINN)
Ciclosporin Chemical formula
Synonyms: 27-400; Ciclosporina; Ciclosporina A; Ciclosporine; Ciclosporinum; Ciklosporin; Ciklosporinas; Cyclosporin; Cyclosporin A; Cyclosporine losporin. Cyclo{-[4-(E)-but-2-enylN,4-dimethylhomoalanyl-(N-methylglycyl)-(N-methylthylleucyl)-(N-methyl
Cyrillic synonym: Циклоспорин.

Chemical information

Chemical formula: C62H111N11O12 = 1202.6.
CAS — 59865-13-3.
ATC — L04AD01.
ATC Vet — QL04AD01; QS01XA90.

Pharmacopoeias.

In Chin., Eur., Int., Jpn, and US.

Ph. Eur. 6.2

(Ciclosporin). A substance produced by Beauveria nivea (=Tolypocladium inflatum Gams) or obtained by any other means. A white or almost white powder; practically insoluble in water; freely soluble in dehydrated alcohol and in dichloromethane. Store in airtight containers. Protect from light.

USP 31

(Cyclosporine). A white to almost white powder. Practically insoluble in water; soluble in alcohol, in acetone, in chloroform, in dichloromethane, in ether, and in methyl alcohol; slightly soluble in saturated hydrocarbons. Store in airtight containers. Protect from light.

Incompatibility.

Tacrolimus inhibits ciclosporin metabolism in vitro5 but did not alter the pharmacokinetics of intravenous ciclosporin in 7 liver transplant patients.6 However, there is a possibility of increased nephrotoxicity when the drugs are used together, so licensed product information contraindicates such use.
1. Strehlau J, et al. Interleukin-2 receptor antibody-induced alterations of ciclosporin dose requirements in paediatric transplant recipients. Lancet 2000; 356: 1327–8
2. Vester U, et al. Basiliximab in paediatric liver-transplant recipients. Lancet 2001; 357: 388–9
3. Vrahnos D, et al. Cyclosporin levels during OKT3 treatment of acute renal allograft rejection. Pharmacotherapy 1991; 11: 278
4. Vasquez EM, Pollak R. OKT3 therapy increases cyclosporine blood levels. Clin Transplant 1997; 11: 38–41
5. Venkataramanan R, et al. Pharmacokinetics of FK 506 in transplant patients. Transplant Proc 1991; 23: 2736–40
6. Jain AB, et al. Pharmacokinetics of cyclosporine and nephrotoxicity in orthotopic liver transplant patients rescued with FK 506. Transplant Proc 1991; 23: 2777–9.

Methoxsalen.

In a pharmacokinetic study, a single oral dose of methoxsalen significantly increased the oral bioavailability of ciclosporin.1
1. Rheeders M, et al. Drug-drug interaction after single oral doses of the furanocoumarin methoxsalen and cyclosporine. J Clin Pharmacol 2006; 46: 768–75.

Methylphenidate.

Methylphenidate led to an increase in ciclosporin concentrations in a 10-year-old African American boy, necessitating reduction of the ciclosporin dose.1

Preparations

USP 31: Cyclosporine Capsules; Cyclosporine Injection; Cyclosporine Oral Solution.

Proprietary Preparations

Arg.: Cermox; Gengraf†; Restasis; Sandimmun; Austral.: Cicloral; Cysporin; Neoral; Sandimmun; Austria: Cicloralhexal; Neoimmun; Sandimmun; Belg.: Neoral-Sandimmun; Sandimmun; Braz.: Gengraf; Restasis; Sandimmun; Sigmasporin; Zinograf†; Canad.: Neoral; Sandimmune; Chile: Gengraf; Modusik-A; Restasis; Sandimmun; Cz.: Consupren†; Equoral; Sandimmun; Sigmasporon; Denm.: Sandimmun; Fin.: Sandimmun; Fr.: Ne oral; Sandimmun; Ger.: Cicloral; Immunosporin; Sandimmun; Gr.: Restasis; Sandimmun; Hong Kong: Gengraf; Sandimmun; Hung.: Sandimmun; India: Imusporin; Panimun Bioral; Sandimmun; Indon.: Sandimmun; Irl.: Neoral; Sandimmun; Israel: Deximune; Sandimmun; Sangcya; Ital.: Sandimmun; Jpn: Papilock; Malaysia: Gengraf; Sandimmun; Mex.: Immulem; Modusik-A; Restasis; Sandimmun; Supremunn; Neth.: Neoral; Sandimmune; Norw.: Sandimmun; NZ: Gengraf; Neoral; Sandimmun; Philipp.: Restasis; Sandimmun; Pol.: Equoral; Sandimmun; Port.: Ciclostar; Sandimmun; Rus.: Consupren (Консупрен); Sandimmun (Сандиммун); S.Afr.: Ciclohexal; Sandimmun; Singapore: Gengraf; Spain: Sandimmun; Swed.: Sandimmun; Switz.: Ciclosol; Sandimmun; Thai.: Consupren; Equoral; Gengraf; Restasis; Sanda; Sandimmun; Turk.: Gengraf; Sandimmun; UAE: Sigmasporin; UK: Neoral; Sandimmun; USA: Gengraf; Neoral; Restasis; Sandimmune; Venez.: Imusporin; Restasis; Sandimmun.
Published October 20, 2018.