SandIMMUN (50mg/ml) 10 Ampoule Injections

Cyclosporin is a potent immunosuppressive agent that primarily acts by inhibiting T-lymphocyte activation. It selectively binds to cyclophilin, a cytosolic protein in T-lymphocytes, forming a cyclosporin-cyclophilin complex. This complex then blocks the calcium-dependent signaling pathway in T-cells by inhibiting the enzyme calcineurin. Calcineurin is responsible for activating a transcription factor known as NF-AT (nuclear factor of activated T-cells), which is essential for the expression of genes required for T-cell activation, such as interleukin-2 (IL-2). By inhibiting calcineurin, cyclosporin prevents the translocation of NF-AT into the nucleus, thereby suppressing the production of IL-2 and other cytokines, and ultimately inhibiting T-cell-mediated immune responses.

Cyclosporin

Immunosuppressant

Injection

The following are the uses of Cyclosporin injection:

• Used for preventing organ rejection in transplant patients.
• Used for managing severe rheumatoid arthritis.
• Used to treat severe psoriasis and atopic dermatitis.
• Used for preventing graft-versus-host disease in bone marrow transplant patients.
• Used for treating nephrotic syndrome.
• Used in severe cases of Crohn's disease.
• Used to control autoimmune conditions like myasthenia gravis.

In the case of an overdose of Cyclosporin injection, prompt medical intervention is necessary. Symptoms may include kidney damage, high blood pressure, and tremors. It is important to seek medical help immediately, as the healthcare provider will determine the most appropriate treatment, which may include monitoring kidney function, controlling blood pressure, and providing supportive care to manage symptoms and prevent further complications. The treatment approach will depend on the severity of the overdose.

In the case of a missed dose of Cyclosporine injection, it is important to take the following steps If you remember within a few hours of the missed dose, administer the injection as soon as possible. However, if it is almost time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose to make up for a missed one, as this may increase the risk of side effects. Consult your healthcare provider if you have any concerns or questions regarding missed doses. They can provide guidance on how to manage missed doses and ensure the effectiveness of your treatment.

To administer the Cyclosporin injection, clean the injection site with an alcohol swab, insert the needle at a 90-degree angle, inject the prescribed dose slowly, and then withdraw the needle, applying pressure with a sterile gauze pad if needed to prevent bleeding.

Here are the conditions or situations when Cyclosporin injection should not be used:

• Allergy Should not be administered to individuals with a known or suspected allergy or hypersensitivity to Cyclosporin or any of its components.
• Malignancies Contraindicated in patients with certain types of cancers or malignancies, especially skin cancers or lymphomas.
• Severe Infections Not recommended for patients with uncontrolled or severe infections, as it can further suppress the immune system.
• Uncontrolled High Blood Pressure Cyclosporin should not be used if blood pressure is not well-controlled, as it can lead to further elevation in blood pressure.
• Kidney Disease Should not be used in individuals with severe kidney impairment or end-stage renal disease.
• Liver Disease Contraindicated in patients with severe liver disease or liver failure.
• Pregnancy and Breastfeeding Not recommended during pregnancy or while breastfeeding, as it can cause harm to the developing fetus or infant.
• Uncontrolled Epilepsy Should not be used in patients with poorly controlled epilepsy or seizures.
• Certain Blood Disorders Contraindicated in individuals with uncontrolled or severe blood disorders, such as pure red cell aplasia or aplastic anemia.
• Autoimmune Diseases (under certain conditions) Not suitable for patients with certain autoimmune diseases like psoriasis or rheumatoid arthritis if they are unstable or severe.

The side effects of Cyclosporin injection may include:

• Kidney problems
• High blood pressure
• Headache
• Nausea and vomiting
• Tremors or shaking
• Increased hair growth
• Gum swelling or pain
• Skin rashes or itching

Following are the precautions and warnings for Cyclosporin injection:

• Cyclosporin should be used with caution in patients with kidney or liver disease, as it can affect these organs and regular monitoring is required.
• This medication may cause high blood pressure, therefore blood pressure monitoring is essential during treatment.
• Patients with a history of cancer or skin disorders should inform their doctor, as Cyclosporin can increase the risk of skin cancer and lymphoma.
• Avoid using this medication if you have a known allergy to Cyclosporin or any of its ingredients, as it may cause severe allergic reactions.
• Cyclosporin can weaken your immune system, making you more prone to infections. Inform your doctor if you develop any signs of infection.
• Avoid live vaccines during treatment and consult your doctor for alternative vaccination schedules.
• This medication may cause gum swelling and excessive hair growth; maintain good oral hygiene and inform your doctor if these symptoms become bothersome.

Following are the drug interactions for Cyclosporin injection:

• Amphotericin B, cotrimoxazole, and metronidazole may increase the risk of kidney toxicity when used with Cyclosporin.
• Cyclosporin can increase levels of HMG-CoA reductase inhibitors (e.g., simvastatin), potentially leading to muscle-related side effects.
• Drugs that inhibit or induce the CYP3A4 enzyme, such as azoles, macrolides, and rifampicin, can alter Cyclosporin levels and require dosage adjustments.
• Phenytoin, carbamazepine, and sodium valproate may increase Cyclosporin metabolism, requiring monitoring and dosage adjustments.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) and potassium-sparing diuretics can increase Cyclosporin levels, necessitating close monitoring.
• Cyclosporin may increase the blood levels of certain calcium channel blockers, such as nifedipine, potentially leading to side effects.
• Co-administration with other immunosuppressants like tacrolimus or sirolimus requires careful monitoring due to potential additive effects and toxicity.

Following are the food interactions for Cyclosporin injection:

• Grapefruit juice should be avoided as it can significantly increase the blood levels of Cyclosporin, leading to potential toxicity.
• Alcohol consumption should be limited or avoided as it can affect the metabolism of Cyclosporin, increasing the risk of side effects.
• High-fat meals can reduce the absorption of Cyclosporin, so it is generally advised to take the medication on an empty stomach or with a light meal.
• Cranberry juice may decrease the effectiveness of Cyclosporin, so it's best to avoid or limit its consumption.
• Avoid potassium-rich foods like bananas, oranges, and tomatoes as Cyclosporin can increase potassium levels in the blood.
• Avoid excessive salt or sodium-rich foods as Cyclosporin can lead to sodium retention, affecting blood pressure.
• Consult your doctor if you regularly consume herbal teas or supplements, as some herbs like St. John's Wort may interfere with Cyclosporin's metabolism.
• Always inform your healthcare provider about your dietary habits to ensure the safe and effective use of Cyclosporin injection.

Cyclosporin injection should be stored in a controlled environment, preferably between 2°C and 8°C (36°F and 46°F) in a refrigerator. Protect the medication from light and do not freeze it, as this can damage the solution. Always check the expiration date on the vial before use and discard any expired or unused vials according to local regulations. Do not dispose of this medication by flushing it down the toilet or pouring it into a drain; instead, contact your healthcare provider or pharmacist for guidance on safe disposal practices. Keep Cyclosporin injection out of the sight and reach of children and pets to prevent accidental exposure or ingestion.

Following are the quick tips for Cyclosporin injection:

• Ensure you receive the injection under medical supervision and as directed by your healthcare provider.
• Cyclosporin injection should be administered by a trained healthcare professional.
• Follow the prescribed dosage and schedule provided by your doctor.
• Do not self-inject unless specifically trained to do so.
• Inform your doctor about all medications and supplements you are taking.
• Report any side effects or unusual symptoms promptly to your healthcare provider.
• Store the injection as directed on the packaging or as instructed by your pharmacist.