Sandimmune
 
What is Sandimmune and why is it prescribed?
Sandimmune is given after organ transplant surgery to help prevent rejection of organs by holding down the body's immune system. It is also used to avoid long-term rejection in people previously treated with other immunosuppressant drugs, such as Imuran. Some doctors prescribe Sandimmune to treat alopecia areata, aplastic anemia, Crohn's disease, and nephropathy. Sandimmune is sometimes used in the treatment of severe skin disorders, including psoriasis and dermatomyositis. Sandimmune is also used in procedures involving bone marrow, the pancreas, and the lungs. Sandimmune is always given with prednisone or a similar steroid. It is available in capsules and liquid, or as an injection. If you take Sandimmune orally over a period of time, your doctor will monitor your blood levels of cyclosporine to make sure your body is receiving the correct amount of Sandimmune. The reason for this repeated testing is that the absorption of this drug in the body is erratic. Constant monitoring is necessary to prevent toxicity due to overdosing or to prevent possible organ rejection due to underdosing. It is important to note that Sandimmune may need to be taken by mouth for an indefinite period following surgery.

How should you take Sandimmune?
Follow your doctors directions for taking Sandimmune. Take the Sandimmune capsule or oral liquid at the same time every day. You may take the medication either with a meal or between meals, but be consistent. To make Sandimmune oral liquid more palatable, you may mix it with room-temperature milk, chocolate milk, or orange juice. Try to use the same beverage as often as possible. Use a container made of glass, not plastic. Never let the mixture stand. Drink it as soon as you prepare it. To make sure you get your full dose, rinse the glass with a little more liquid and drink that too. You should maintain good dental hygiene and see your dentist frequently for cleaning to prevent tenderness, bleeding, and gum enlargement. After you use the dosage syringe to transfer the oral solution to a glass, dry the outside of the syringe with a clean towel and put it away. Do not rinse or wash it. If you do have to clean it, make sure it is thoroughly dry before you use it again. You may notice an odor when you open the capsule container. This is nothing to worry about and will soon dissipate. If you miss a dose and fewer than 12 hours have passed, take it as soon as you remember. If it is almost time for the next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once. Store both the capsules and the oral solution below 86 degrees F. Do not store the liquid in the refrigerator. Keep the liquid from freezing. Sandimmune liquid, once opened, must be used within 2 months.

Are there any Sandimmune side effects?
Sandimmune side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. The principal side effects of Sandimmune are high blood pressure, hirsutism, kidney damage, excessive growth of the gums, and tremor. Other common Sandimmune side effects may include abdominal discomfort, acne, breathing difficulty, convulsions, coughing, cramps, diarrhea, flu-like symptoms, flushing, headache, liver damage, lymph system tumor, muscle, bone, or joint pain, nasal inflammation, nausea, numbness or tingling, sinus inflammation, vomiting, and wheezing. Less common Sandimmune side effects may include abdominal distention, allergic reactions, anemia, appetite loss or increase, bleeding gums, blood disorders, brittle fingernails, confusion, conjunctivitis, dizziness, fever, fluid retention, frequent urination, hearing loss, hiccups, high blood sugar, indigestion, infection, insomnia, nervousness, peptic ulcer, rash and other skin disorders, ringing in the ears, stomach inflammation, and vertigo. Rare Sandimmune side effects may include anxiety, blood in the urine, breast development in males, chest pain, constipation, depression, hair breaking, heart attack, itching, joint pain, lymph disorders, mouth sores, night sweats, sluggishness, stomach and upper intestinal bleeding, swallowing difficulty, tingling, visual disturbance, weakness, and weight loss.

What are the possible food and drug interactions when taking Sandimmune?
If Sandimmune is taken with certain other drugs, the effects of either could be increased, decreased, or altered. Be sure to inform your doctor of all the prescription and over the counter medications you are taking. Avoid getting immunizations while you are taking Sandimmune. The drug may make vaccinations less effective or increase your risk of contracting an illness from a live vaccine. Avoid grapefruit and grapefruit juice while taking Sandimmune. Also avoid the antidepressant herb St. John's Wort. This over-the-counter herbal remedy reduces the effect of Sandimmune, and can lead to organ rejection. It is especially important to check with your doctor before combining Sandimmune with Allopurinol (Zyloprim), Amiodarone (Cordarone), Amphotericin B (Fungizone, Abelcet), Bromocriptine (Parlodel), Calcium-blocking heart and blood pressure medications (such as Calan, Cardene, Procardia, and Cardizem), Carbamazepine (Tegretol), Cimetidine (Tagamet), Clarithromycin (Biaxin), Colchicine, Danazol (Danocrine), Diclofenac (Voltaren, Cataflam), Digoxin (Lanoxin, Lanoxicaps), Erythromycin (E.E.S., Erythrocin, others), Fluconazole (Diflucan), Gentamicin (Garamycin), Indinavir (Crixivan), Itraconazole (Sporanox), Ketoconazole (Nizoral), Lovastatin (Mevacor), Melphalan (Alkeran), Methotrexate, Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol), Metoclopramide (Reglan), Nafcillin (Unipen), Nelfinavir, Nonsteroidal anti-inflammatory drugs (such as Clinoril and Naprasyn), Octreotide (Sandostatin), Orlistat (Xenical), Phenobarbital, Phenytoin (Dilantin), Potassium-sparing diuretics (Dyrenium, Midamor, Aldactone), Prednisolone (Delta-Cortef, Prelone), Quinupristin (Synercid), Ranitidine (Zantac), Rifampin (Rifadin, Rifamate, Rimactane), Ritonavir (Norvir), Saquinavir (Fortovase), Ticlopidine (Ticlid), Tacrolimus (Prograf), Tobramycin (Nebcin), Trimethoprim/sulfamethoxazole (Bactrim, Septra), or Vancomycin (Vancocin).

Are there any special warnings about Sandimmune?
When your immune system is suppressed by Sandimmune, you are at increased risk of infection and of certain malignancies, including skin cancer and lymph system cancer. High-dose Sandimmune is toxic to the liver and kidneys and may cause serious kidney damage. Because this toxicity has symptoms similar to those of transplant rejection, you must be monitored closely. If your body is trying hard to reject a transplanted organ, your doctor will probably allow the rejection to occur rather than give you a very high dose of Sandimmune. Sandimmune can raise blood pressure, especially in older people. If it develops while you are taking the drug for arthritis or psoriasis, the doctor may lower your dose. Brain disorders have developed in patients taking Sandimmune, sometimes leading to convulsions, loss of movement, vision problems, impaired consciousness, and psychiatric disturbances. The chance of convulsions is greater if you are taking high doses of steroid drugs, particularly methylprednisolone (Medrol). Brain-related disorders usually clear up once Sandimmune is discontinued. Use a barrier method of contraception, such as diaphragms or condoms, during Sandimmune therapy. Do not use oral contraceptive pills without your doctor's approval. Do not try to change dosage forms without consulting your doctor.
 

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