Neoral

Neoral (cyclosporine modified) is a critical immunosuppressive agent formulated to prevent organ rejection in transplant recipients. Its advanced microemulsion technology ensures more consistent and predictable absorption than previous formulations, allowing for precise therapeutic management. Trusted by specialists worldwide, Neoral provides reliable immunosuppression, supporting long-term graft survival and improving patient outcomes through optimized pharmacokinetics.

Features

• Microemulsion formulation for enhanced bioavailability
• Consistent and predictable absorption profile
• Available in 25 mg and 100 mg soft gelatin capsules
• Oral solution (100 mg/mL) for flexible dosing
• Calcineurin inhibitor mechanism of action
• Narrow therapeutic index requiring therapeutic drug monitoring

Benefits

• Significantly reduces risk of acute and chronic organ rejection
• Provides stable blood concentration levels for consistent immunosuppression
• Allows for personalized dosing based on therapeutic drug monitoring
• Supports long-term graft function and survival
• Enables reduced corticosteroid usage in maintenance therapy
• Offers flexible administration options for varied patient needs

Common use

Neoral is primarily indicated for the prophylaxis of organ rejection in patients receiving allogeneic kidney, liver, and heart transplants. It is also used in combination with other immunosuppressive agents. Additionally, Neoral is prescribed for severe, active rheumatoid arthritis and severe psoriasis in adult patients who have failed to respond adequately to conventional therapies. The medication requires careful patient selection and continuous monitoring throughout treatment.

Dosage and direction

Initial dose: Kidney transplantation: 8-15 mg/kg/day, Liver transplantation: 8-15 mg/kg/day, Heart transplantation: 7-10 mg/kg/day. Divide daily dose into two administrations taken 12 hours apart.

Maintenance dosing: Typically reduced gradually to 3-10 mg/kg/day based on therapeutic drug monitoring results. Dose adjustments must be guided by cyclosporine blood trough levels, renal function, and clinical response.

Administration: Take consistently with regard to meals at the same time each day. Swallow capsules whole with water; do not break or chew. Oral solution should be mixed with room temperature orange or apple juice (preferably) in a glass container, stirred well, and consumed immediately.

Precautions

• Requires regular monitoring of blood pressure, renal function, and cyclosporine blood levels
• Increased susceptibility to infections and possible development of lymphoma
• Monitor for signs of neurotoxicity, including tremors and headache
• Regular ophthalmological examinations recommended due to possible visual disturbances
• Avoid live vaccines during therapy
• Exercise caution in patients with hypertension, renal impairment, or hepatic dysfunction
• Pregnancy Category C: use only if potential benefit justifies potential risk to fetus

Contraindications

• Hypersensitivity to cyclosporine or any component of the formulation
• Patients with abnormal renal function, uncontrolled hypertension, or uncontrolled infections
• Concurrent use with potassium-sparing diuretics or other nephrotoxic drugs
• Live vaccinations during immunosuppressive therapy
• Patients with history of malignancies (relative contraindication)
• Breastfeeding mothers

Possible side effect

Common (≥1%): Hypertension, renal dysfunction, tremor, headache, hypertrichosis, gum hyperplasia, gastrointestinal disturbances, hyperlipidemia, hyperkalemia, hypomagnesemia

Serious (<1%): Nephrotoxicity, hepatotoxicity, anaphylaxis, thrombotic microangiopathy, posterior reversible encephalopathy syndrome (PRES), severe infections, malignancies including skin cancer and lymphoma, pancreatitis

Drug interaction

• Strong CYP3A4 inhibitors (ketoconazole, clarithromycin): increase cyclosporine levels
• Strong CYP3A4 inducers (rifampin, phenytoin): decrease cyclosporine levels
• Nephrotoxic agents (aminoglycosides, NSAIDs): increased renal toxicity risk
• Potassium-sparing diuretics, ACE inhibitors: increased hyperkalemia risk
• Grapefruit juice: increases bioavailability - avoid concomitant use
• Live vaccines: diminished immune response

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed administration. Maintain regular dosing schedule and contact your healthcare provider if multiple doses are missed. Consistent timing is critical for maintaining therapeutic drug levels.

Overdose

Symptoms may include nausea, vomiting, lethargy, headache, tachycardia, and renal impairment. Severe overdose can lead to hepatotoxicity, seizures, and coma. Management includes immediate gastric lavage if ingestion recent, supportive care, and monitoring of renal and hepatic function. Hemodialysis is not effective due to high protein binding; charcoal hemoperfusion may be considered in severe cases.

Storage

Store at room temperature (15-30°C/59-86°F). Keep capsules in original container, tightly closed. Protect from moisture and light. Oral solution should be stored in original container at room temperature and used within 2 months after opening. Do not freeze. Keep out of reach of children and pets.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any medication regimen. Dosage and administration must be determined by a physician familiar with the patient’s medical history and current condition. Therapeutic drug monitoring is essential for safe and effective use.

Reviews

“Neoral has transformed our transplant program outcomes. The predictable absorption profile allows for much more precise dosing compared to previous formulations.” - Transplant Nephrologist, 15 years experience

“Our center has observed significantly improved long-term graft survival since switching to Neoral. The consistency in blood levels makes management considerably easier.” - Hepatology Specialist

“While requiring careful monitoring, Neoral remains a cornerstone of our immunosuppressive protocols. The microemulsion technology represents a significant advancement in patient care.” - Rheumatology Department Head