To determine the concentration of cyclosporine in your blood in order to establish a dosing regimen, maintain therapeutic levels, and detect toxic levels
To determine the concentration of cyclosporine in your blood in order to establish a dosing regimen, maintain therapeutic levels, and detect toxic levels
As soon as cyclosporine therapy begins, usually daily or 2-3 times a week, and periodically after that as the dose is adjusted or maintained
A blood sample drawn from a vein in your arm
None. Typically a trough level is monitored. A trough level is the lowest concentration reached by a drug before the next dose is administered. For example, if cyclosporine is given twice a day, a blood sample is usually drawn 12 hours after the last dose, before a new dose is given. On mornings when you are scheduled to have your cyclosporine level checked, do not take the medicine until after your blood is drawn.
Cyclosporine is an immunosuppressant drug used to reduce the body’s natural defenses. This test measures the amount of cyclosporine in the blood.
When people undergo an organ transplant, their immune system recognizes the graft as “foreign” and will begin to attack it just as it would any invasive bacteria or virus. Cyclosporine diminishes the ability of certain white blood cells in the immune system to respond to this foreign tissue. The transplanted organ then has a better chance of survival and will not be as easily rejected by the transplant recipient’s immune system. Cyclosporine is used routinely in the transplantation of kidney, heart, liver, and other organs.
The immunosuppressant qualities of cyclosporine have also been found to be useful in treating symptoms of some autoimmune and other disorders. These conditions are characterized by the immune system reacting to the body’s own cells or tissue. Cyclosporine helps to control the immune response in these cases, decreasing the severity of symptoms. Some examples of these conditions include rheumatoid arthritis, psoriasis, aplastic anemia, and Crohn disease.
When the symptoms in these cases are judged to be severe, extensive, and disabling, cyclosporine may be prescribed. Usually, the symptoms have not diminished with other treatments or medications. Cyclosporine is used with caution in these cases and needs to be carefully monitored with blood tests.
Testing cyclosporine levels in the blood can help ensure that drug levels are in a range that will be therapeutic. If the level is too low, organ rejection may occur (in the case of transplantation) or symptoms may reappear (autoimmune cases). It is also important to ensure that the level is not too high and will not result in toxicity.
Tests for cyclosporine are used to measure the amount of this drug in the blood to determine whether cyclosporine concentrations have reached therapeutic levels and are not in a toxic range. Cyclosporine is a drug that diminishes the body’s immune response. It is prescribed for organ transplant recipients to prevent organ rejection and for some people with autoimmune conditions, such as rheumatoid arthritis or psoriasis, to alleviate symptoms.
It is important to monitor levels of the drug for several reasons:
By monitoring cyclosporine blood levels, healthcare practitioners can better ensure that each individual is receiving the right amount and formulation of drug needed to treat his or her particular case, to maximize the therapeutic effects while minimizing the drug toxicity.
Cyclosporine testing is ordered frequently at the start of therapy, often on a daily basis when trying to establish a dosing regimen. Once an appropriate dose has been determined, the level can be tested less frequently and may eventually be tested monthly, once every two months, or at longer intervals. However, testing may be done more often when a person becomes ill or begins taking additional medications that may affect the metabolism of cyclosporine. A change in a person’s metabolic status may also prompt more frequent testing.
Often in transplantation, people will begin with higher doses of cyclosporine at the start of therapy and then decrease the dose over the course of long-term therapy. In the cases of rheumatoid arthritis or psoriasis, if a person appears to tolerate the drug well, the dose may be increased to further improve symptoms.
With each change in dose, blood levels need to be measured. In addition, the frequency of testing depends on a number of factors, including the medical reason for taking cyclosporine. In organ transplantation, the type of organ transplanted and the recipient’s age and general health status will inform dosing. For example, a person with a transplanted liver may need to be monitored more often since cyclosporine is metabolized mainly by the liver and impaired function can slow clearance of cyclosporine from the blood.
When organ rejection or kidney toxicity is suspected, tests may also be ordered more often. Some signs and symptoms of cyclosporine toxicity are:
The therapeutic range for cyclosporine depends on the method used to measure the drug, the type of transplant, and the length of time since the transplant. Results obtained from different types of samples and different methods are not interchangeable. Healthcare practitioners will be guided by the laboratory as to the appropriate therapeutic range to apply to a specific person’s test result.
If trough levels fall below the desired range, there is a risk of transplant rejection or symptom recurrence. If levels detected are above the range, there is a risk of toxic side effects.
Peak concentrations of cyclosporine in samples collected 2 hours post-dose are sometimes tested in transplant cases. High levels of cyclosporine in peak samples are correlated with reduced rejection rates, especially in the first year after transplant surgery.
A majority of laboratories use whole blood samples for cyclosporine testing instead of serum or plasma and will collect samples 12 hours after the last dose or just before the next dose (trough levels).
Some laboratory methods are more specific for the cyclosporine parent drug, while others measure the parent drug plus the metabolites, so their respective ranges will differ. Because cyclosporine therapeutic ranges can vary with type of assay performed by the laboratory, it is recommended that blood samples be tested by the same institution over the course of therapy. Results will be more consistent and will correlate better with the reported therapeutic range.
For conditions other than transplants, cyclosporine may be prescribed with other medications, such as non-steroidal anti-inflammatory drugs (NSAIDs). In transplant cases, other anti-rejection drugs may be used along with cyclosporine. These drugs will work in conjunction to treat a person’s condition. In addition, cyclosporine blood levels can be affected (either increased or decreased) by other medications a person may be taking. It is important for health practitioners to be are aware of what medications and supplements their patients are taking and to be notified of changes in diet or health status that may affect cyclosporine concentrations.
Several prescription drugs can interact dangerously with cyclosporine and should not be taken at the same time. Tell your health care provider about all the medications you are taking.
Cyclosporine may cause high blood pressure and kidney damage. Tell your health care provider if you have or have ever had high blood pressure or kidney disease. Healthcare practitioners may order additional laboratory tests to detect high lipid levels or to monitor kidney and liver function.
Avoid grapefruit juice. It slows the body’s normal breakdown of cyclosporine, allowing it to build up to potentially excessive levels in the blood, and can maintain this effect in the body for three days or more following the last glass of juice.
Magnesium clearance is enhanced by cyclosporine, possibly leading to symptoms related to low blood magnesium. A healthcare practitioner may monitor magnesium levels and treat with supplements as required. High blood potassium sometimes occurs. A healthcare practitioner may monitor potassium levels and will use caution with potassium-sparing diuretics, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, potassium-containing drugs, and potassium-rich diets.
If you are a transplant recipient, you generally will stay on cyclosporine as long as that is the treatment of choice for you. If there are signs of rejection, even with blood levels in the therapeutic range, you may be switched to a different immunosuppressant drug. Also, there is a greater chance of toxic side effects the longer you are on cyclosporine, so a healthcare practitioner may choose to alter drug therapy when you have been on cyclosporine for more than 2-3 years.
If you have an autoimmune disorder such as rheumatoid arthritis, Crohn disease, or psoriasis, you will be treated with cyclosporine only when your symptoms are acute and if other treatments have not been effective. It is not advised that your stay on cyclosporine for more than a year due to an increase in the likelihood of toxic symptoms the longer you are on the medication. Short-term or intermittent courses of 12 weeks at a time are more advisable.
Cyclosporine will usually be monitored by healthcare practitioners who have specific knowledge of the condition or disease for which the drug is prescribed. They tend to be very familiar with cyclosporine and its use in therapy, and they understand the importance of monitoring the drug. They may include your surgeon or doctor treating you for your arthritis or psoriasis.
Sources Used in Current Review
(June 30, 2017) Cyclosporine A, Administration and Monitoring of (Version 11). Available online at https://www.nuh.nhs.uk/handlers/downloads.ashx?id=60846. Accessed on Feb 6, 2018.
Vari C, Tero-Vescan A, Imre S, Muntean Dl. Therapeutic Drug Monitoring Of Cyclosporine In Transplanted Patients. Possibilities, Controversy, Causes For Failure. Farmacia, 2012, Vol. 60, 5
Cambaceres CG, Rojas L, Fernandez MC, Licciardone N, Ferreira O, Diaz A, Moroni A, Moreno AD, Imventarza O. Monitoring Cyclosporine Microemulsion at Two Hours Post Dosing in Pediatric Maintenance Liver Transplant Recipients. Transplantation Proceedings. Volume 42, Issue 1, January–February 2010, Pages 361-362.
(June 1, 2013) BC Cancer Centers Cyclosporine monograph. Available online at https://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Cyclosporine_monograph_1June2013_formatted.pdf. Accessed on Feb 6, 2018.
Psoriasis: Recommendations for cyclosporine | American Academy of Dermatology. Available online at https://www.aad.org/practicecenter/quality/clinical-guidelines/psoriasis/systemic-agents/recommendations-for-cyclosporine. Accessed on Feb 6, 2018.
2017 Clinical Guidelines For Transplant Medications- BC Transplant. Available online at https://www.transplant.bc.ca/Documents/Health%20Professionals/Clinical%20guidelines/Clinical%20Guidelines%20for%20TRANSPLANT%20MEDICATIONS.pdf. Accessed on Feb 6, 2018.
Sources Used in Previous Reviews
A Manual of Laboratory & Diagnostic Tests. 6th ed. Fischbach F, ed. Philadelphia: Lippincott Williams & Wilkins; 2000.
Clinical Chemistry: Principles, Procedures, and Correlations. Bishop M, Duben-Engelkirk J, Fody E, eds. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2000.
Clinical Diagnosis and Management by Laboratory Methods. 20th ed. Henry JB, ed. New York: Saunders: 2001.
Sacher RA, McPherson RA, Campos J. Widmann’s Clinical Interpretation of Laboratory Tests. 11th ed. Philadelphia: F.A. Davis Company; 2000.
Karen L. Hardinger, Pharm.D. Matthew J. Koch, M.D.; Daniel C. Brennan, M.D., FACP (Posted 10/01/2004) Current and Future Immunosuppressive Strategies in Renal Transplantation, Medscape from Pharmacotherapy. Available online at https://www.medscape.com/viewarticle/489357.
TOXNET, Toxicology Data Network (April 2006). Hazardous Substance Database. Division of Specialized Information Services (SIS) of the National Library of Medicine (NLM) (Online information-Search cyclosporine). Available online at https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?HSDB.
Medscape detailed monograph: Oral Cyclosporine (April 2006). Available online through https://www.medscape.com.
Michael R. Lucey; Manal F. Abdelmalek; Rosemarie Gagliardi; Darla Granger; Curtis Holt; Igal Kam; Goran Klintmalm; Alan Langnas; Kirti Shetty; Andreas Tzakis; E. Steve Woodle (2005). A Comparison of Tacrolimus and Cyclosporine in Liver Transplantation: Effects on Renal Function and Cardiovascular Risk Status. Medscape from American Journal of Transplantation 5(5):1111-1119. Available online at https://www.medscape.com/viewarticle/503095.
Well, G (2005). Cyclosporine for treating rheumatoid arthritis. Cochrane Rev Abstract, The Cochrane Collaboration. Available online at https://www.medscape.com/viewarticle/485484.
Naldi, L., Griffiths, CEM (2005). Traditional Therapies in the Management of Moderate to Severe Chronic Plaque Psoriasis: An Assessment of the Benefits and Risks. British Journal of Dermatology 152(4): 597-615. Available online at https://www.medscape.com/viewarticle/503441.
(Revised 2009 December 1). Cyclosporine. MedlinePlus Drug Information [On-line information]. Available online at https://www.nlm.nih.gov/medlineplus/druginfo/meds/a601207.html. Accessed March 2010.
McMillin, G., and Wittwer, C. (Updated 2009 August). Organ Transplantation – Immunosuppressive Drugs. ARUP Consult [On-line information]. Available online at https://www.arupconsult.com/Topics/ImmunosuppressiveDrugs.html?client_ID=LTD. Accessed March 2010.
Pellegrino, B. and Schmidt, R. (Update 2009 October 14). Immunosuppression. eMedicine [On-line information]. Available online at https://emedicine.medscape.com/article/432316-overview. Accessed March 2010.
Malhotra, P. et. al. (Updated 2009 July 28). Immunology of Transplant Rejection. eMedicine [On-line information]. Available online at https://emedicine.medscape.com/article/432209-overview. Accessed March 2010.
(Updated 2010 March 1). Cyclosporine (Oral Route, Intravenous Route). MayoClinic.com [On-line information]. Available online at https://www.mayoclinic.com/health/drug-information/DR601591. Accessed March 2010.
Clarke, W. and Dufour, D. R., Editors (© 2006). Contemporary Practice in Clinical Chemistry: AACC Press, Washington, DC. Pp 462.
Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 1326-1329.
Henry’s Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. McPherson R, Pincus M, eds. Philadelphia, PA: Saunders Elsevier: 2011, Pp 354-355.
Cyclosporine. University of Washington Medical Center. Available online at https://healthonline.washington.edu/document/health_online/pdf/Heart-Transplant-Cyclosporine.pdf. Last reviewed October 2012. Accessed October 21, 2013.
Cyclosporine. Medline Plus. Available online at https://www.nlm.nih.gov/medlineplus/druginfo/meds/a601207.html. Last updated September 1, 2010. Accessed October 21, 2013.
Cyclosporine. NYU Langone Medical Center. Available online at https://www.med.nyu.edu/content?ChunkIID=21718. Last reviewed August 2013. Accessed November 1, 2013.
Cyclosporine Clinic Guidelines for Monitoring Physicians. Vancouver Coastal Health. Avaialble online at https://www.arthritis.ca/document.doc?id=555. Last reviewed April 2012. Accessed November 1, 2013.
(Updated Nov 17, 2011) Pelligrino B. Immunosuppression. Medscape Reference article. Available online at https://emedicine.medscape.com/article/432316-overview. Accessed November 2013.
This form enables patients to ask specific questions about lab tests. Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, American Society for Clinical Laboratory Science. Please allow 2-3 business days for an email response from one of the volunteers on the Consumer Information Response Team.Send Us Your Question