Cyclosporine (Atopica®, Optimmune®, Sandimmune®) for Cats and Dogs

Overview of Cyclosporine for Canines and Felines

• Cyclosporine, commonly known by the brand names of Atopica®, Optimmune®, Sandimmune®, is an immunosuppressant drug commonly used in dogs and cats to treat diseases such as allergic dermatitis, and perianal fistulas in dogs.
• The immune system is the body’s highly complicated mechanism for developing protection against infection or toxic substances. Immunity involves both blood factors (such as antibodies) and cellular factors. Essential for survival, immune-system response can lead to disorders called autoimmune diseases. Cyclosporine belongs to a class of drugs known as immunosuppressants.
• Cyclosporine affects calcium-ion uptake in a specific white blood cell (the lymphocyte), rendering that cell ineffective.
• By affecting many white blood cells in this manner, the immune system is suppressed.
• Cyclosporine is a prescription drug and can only be obtained from a veterinarian or by prescription from a veterinarian.
• When administered orally, this drug is not approved for use in animals by the Food and Drug Administration but it is prescribed legally by veterinarians as an extra-label drug. This drug is approved for use in dogs as a topical eye ointment.

Brand Names or Other Names of Cyclosporine

• This drug is registered for use in humans and animals.
• Human formulations: Sandimmune® (Sandoz), Neora® (Sandoz)
• Veterinary formulations: Atopica® (Novartis), Optimmune® (Schering)

Uses of Cyclosporine for Dogs and Cats

• Cyclosporine is prescribed to suppress the immune system in diseases such as immune mediated hemolytic anemia, perineal fistula, atopic dermatitis, and keratoconjunctivitis sicca (dry eye).
• Cyclosporine also can be used to prevent rejection after kidney or bone-marrow transplants.
• Cyclosporine is commonly used to treat allergic skin diseases in dogs and cats. It is estimated that approximately 70% of allergic dogs will respond to treatment with cyclosporine with at least a 50% reduction in their skin lesions and itching.
• Cyclosporine is also used to treat perianal fistulas in dogs.

Precautions and Side Effects

• While generally safe and effective when prescribed by a veterinarian, cyclosporine can cause side effects in some animals.
• Cyclosporine should not be used in animals with known hypersensitivity or allergy to the drug.
• Cyclosporine should not be used except in animals with significant immune-system disease to s history of cancer.
• The drug should be avoided in animals with kidney impairment, stomach ulcers, and certain blood disorders.
• The most common adverse effect of cyclosporine treatment is lack of appetite. Other adverse effects include vomiting, soft or mucoid stools and diarrhea.
• Cyclosporine may interact with other medications. Consult with your veterinarian to determine if other drugs your pet is receiving could interact with cyclosporine.
• Prolonged use of cyclosporine can result in bacterial or fungal infection related to suppression of the immune system. This allows microorganisms that would normally be fought off to become disease-forming. It is recommended to treat all such infections prior to initiating therapy.
• Long-term use can also promote the development of cancers, such as a cancer of the lymph glands (lymphoma). Some dogs (less than 2% on long term therapy) will also develop overgrowth of the gum tissue (gingival hyperplasia). Dogs on cyclosporine are also more prone to urinary tract infections.
• The safety of cyclosporine has not been determined in breeding, pregnant, or lactating dogs, in dogs less than 6 months of age or weighing less than 2 kg (4.5 pounds).
• Because cyclosporine has a bitter taste, it may not be easy to administer without placing the medication in a gelcap (gelatin capsule).

How Cyclosporine Is Supplied

• Cyclosporine is available in 25 mg and 100 mg tablets. Atopica® formulation is available in 10, 25, 50 and 100 mg sizes.
• It is also available in an injectable form.
• There is an ophthalmic preparation that is available for specific treatment of the eye.

Dosing Information of Cyclosporine for Dogs and Cats

• Medication should never be administered without first consulting your veterinarian.
• It is recommended to give oral medication at least two hours before or after feeding.
• The dose of cyclosporine recommended in dogs is 1.5 to 3 mg per pound (3 to 7 mg/kg) twice daily. In dogs on cyclosporine for allergic skin disease, the dose is often tapered after about 30 days of therapy.
• In cats, 2 to 3 mg per pound (4 to 6 mg/kg) twice daily is most often recommended.
• Periodic blood tests may be necessary to ensure adequate dosage of cyclosporine and prevent complications of treatment.
• Cyclosporine is sometimes given with the drug ketoconazole. Ketoconazole interferes with the metabolism of cyclosporine which can reduce the amount of cyclosporine needed which can help reduce the cost of this expensive drug.
• The duration of administration depends on the condition being treated, response to the medication and the development of any adverse effects. Be certain to complete the prescription unless specifically directed by your veterinarian. Even if your pet feels better, the entire treatment plan should be completed to prevent relapse or prevent the development of resistance.