Neoral: Advanced Immunosuppression for Organ Transplant Success
| Product dosage: 100mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 10 | $7.14 | $71.38 (0%) | 🛒 Add to cart |
| 20 | $5.72 | $142.76 $114.38 (20%) | 🛒 Add to cart |
| 30 | $4.90 | $214.14 $147.06 (31%) | 🛒 Add to cart |
| 60 | $4.82 | $428.28 $288.96 (33%) | 🛒 Add to cart |
| 90 | $4.73 | $642.42 $425.70 (34%) | 🛒 Add to cart |
| 120 | $4.64 | $856.56 $557.28 (35%) | 🛒 Add to cart |
| 180 | $4.56 | $1284.84 $820.44 (36%) | 🛒 Add to cart |
| 270 | $4.47 | $1927.26 $1207.44 (37%) | 🛒 Add to cart |
| 360 | $4.30
Best per pill | $2569.68 $1548.00 (40%) | 🛒 Add to cart |
| Product dosage: 25mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 10 | $3.87 | $38.70 (0%) | 🛒 Add to cart |
| 20 | $3.01 | $77.40 $60.20 (22%) | 🛒 Add to cart |
| 30 | $2.84 | $116.10 $85.14 (27%) | 🛒 Add to cart |
| 60 | $2.45 | $232.20 $147.06 (37%) | 🛒 Add to cart |
| 90 | $2.32 | $348.30 $208.98 (40%) | 🛒 Add to cart |
| 120 | $2.24 | $464.40 $268.32 (42%) | 🛒 Add to cart |
| 180 | $2.15 | $696.60 $387.00 (44%) | 🛒 Add to cart |
| 270 | $2.06 | $1044.90 $557.28 (47%) | 🛒 Add to cart |
| 360 | $1.98
Best per pill | $1393.20 $712.08 (49%) | 🛒 Add to cart |
Synonyms | |||
Neoral (cyclosporine, modified) is a critical immunosuppressive agent specifically formulated to prevent organ rejection in transplant recipients. As a microemulsion, it offers improved and more consistent bioavailability compared to conventional cyclosporine formulations, allowing for more predictable blood concentration levels and enhanced therapeutic outcomes. This advanced formulation represents a significant evolution in post-transplant care, providing clinicians with a reliable tool for long-term graft survival. Its precise mechanism targets T-lymphocyte activation, selectively modulating the immune response while minimizing broad-spectrum immunosuppression.
Features
- Microemulsion formulation for enhanced bioavailability
- Consistent and predictable pharmacokinetic profile
- Soft gelatin capsules for improved patient compliance
- Available in multiple strengths (25 mg and 100 mg)
- Temperature-stable formulation
- Precisely calibrated blood level monitoring compatibility
- Pediatric-friendly oral solution available
- Manufactured under strict quality control standards
Benefits
- Significantly reduces risk of acute organ rejection episodes
- Provides stable and predictable immunosuppression levels
- Enables personalized dosing based on therapeutic drug monitoring
- Maintains long-term graft function and survival
- Reduces corticosteroid dependence in maintenance therapy
- Offers flexible dosing options for diverse patient populations
Common use
Neoral is primarily indicated for the prophylaxis of organ rejection in patients receiving kidney, liver, and heart allogeneic transplants. It is also used in combination with other immunosuppressive agents, typically corticosteroids and sometimes antiproliferative agents, as part of a comprehensive immunosuppressive regimen. The medication may be used in certain autoimmune conditions where conventional therapy has proven inadequate, though this represents an off-label application requiring careful specialist supervision.
Dosage and direction
Initial dosing should begin 4-12 hours prior to transplantation or may be administered post-operatively once the patient is hemodynamically stable. The recommended initial dose is 10-15 mg/kg/day for kidney transplant patients, 8-10 mg/kg/day for liver transplant patients, and 7-10 mg/kg/day for heart transplant patients, administered in two divided doses. Dosage must be individualized based on therapeutic drug monitoring, with target trough concentrations typically maintained between 100-400 ng/mL in the early post-transplant period, gradually decreasing during maintenance therapy. Regular blood level monitoring is essential throughout treatment.
Dosage adjustments should be made gradually, with changes not exceeding 25% at any one time. The medication should be administered consistently with respect to food intake, preferably at the same time each day. Capsules should be swallowed whole with water, not chewed or broken. The oral solution should be measured precisely using the supplied dosing syringe and may be mixed with room temperature orange or apple juice (not grapefruit juice) to improve palatability.
Precautions
Patients require regular monitoring of renal function, liver enzymes, blood pressure, and cyclosporine blood levels. Blood pressure should be monitored frequently, as hypertension is a common adverse effect. Renal function must be assessed serially, as nephrotoxicity can occur even at therapeutic doses. Neurologic monitoring is recommended, particularly in liver transplant patients who may be more susceptible to neurotoxic effects.
Patients should be advised to avoid grapefruit and grapefruit juice, which can significantly increase cyclosporine blood concentrations. Care should be taken with other CYP3A4 inhibitors and inducers. Vaccination may be less effective during therapy, and live vaccines should generally be avoided. Patients should use effective sun protection due to increased risk of skin malignancies. Regular dermatological examinations are recommended.
Contraindications
Neoral is contraindicated in patients with hypersensitivity to cyclosporine or any component of the formulation. It should not be used concurrently with PUVA or UVB therapy in psoriasis patients. Concomitant administration with strong CYP3A4 inhibitors such as ketoconazole, itraconazole, voriconazole, clarithromycin, or telithromycin is generally contraindicated unless closely monitored. The medication is contraindicated in patients with uncontrolled hypertension, malignancies, or significant hepatic impairment without careful risk-benefit assessment.
Possible side effects
Common adverse effects include hypertension (occurring in approximately 25% of patients), renal dysfunction (25%), tremor (20%), hirsutism (15%), gum hyperplasia (10%), and gastrointestinal disturbances including nausea and diarrhea (15%). Hyperlipidemia occurs in approximately 15% of patients. Less frequent but serious adverse effects include nephrotoxicity, hepatotoxicity, neurotoxicity (including seizures and encephalopathy), and increased susceptibility to infections and malignancies.
Long-term therapy may lead to structural changes in the kidney, including interstitial fibrosis. Hematologic effects such as leukopenia and thrombocytopenia may occur. Metabolic complications including hyperkalemia, hypomagnesemia, and hyperuricemia may develop. Pancreatitis, though rare, has been reported. Visual disturbances including optic disc edema and papilledema may occur in some patients.
Drug interaction
Neoral interacts significantly with medications that affect CYP3A4 metabolism. Strong inhibitors (ketoconazole, itraconazole, clarithromycin) can increase cyclosporine levels by 2-5 fold. Inducers (rifampin, phenytoin, St. John’s wort) can decrease levels by up to 90%. Other significant interactions occur with aminoglycosides, amphotericin B, and NSAIDs which may enhance nephrotoxicity. Potassium-sparing diuretics and ACE inhibitors may increase hyperkalemia risk. Statins may have increased myopathy risk when co-administered.
Antimicrobials including vancomycin, trimethoprim/sulfamethoxazole, and acyclovir may increase nephrotoxic potential. Calcium channel blockers (particularly diltiazem and verapamil) can increase cyclosporine concentrations. Grapefruit juice must be avoided due to potent inhibition of CYP3A4. Monitoring and dosage adjustment are essential when adding or discontinuing interacting medications.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should never double the dose to make up for a missed administration. Consistent timing of doses is critical for maintaining stable blood levels, so patients should be counseled on adherence strategies and the importance of maintaining the dosing schedule.
Healthcare providers should be notified of missed doses, particularly if multiple doses are missed, as this may require additional monitoring or temporary adjustment of the therapeutic regimen. Patients should be advised to use pill organizers or alarm reminders to improve adherence. Documentation of missed doses should be maintained for reference during therapeutic drug monitoring appointments.
Overdose
Cyclosporine overdose may manifest as elevated serum creatinine, hepatotoxicity, nausea, vomiting, lethargy, hypertension, and electrolyte disturbances. In severe cases, seizures, coma, and life-threatening renal failure may occur. Management includes immediate discontinuation of the medication, gastric lavage if ingestion was recent, and supportive care including maintenance of renal perfusion. Hemodialysis is not effective due to high protein binding, though charcoal hemoperfusion may be considered in severe cases.
Symptomatic treatment should address specific manifestations: antihypertensives for hypertension, anticonvulsants for seizures, and electrolyte correction as needed. Close monitoring of renal and hepatic function is essential. Serum cyclosporine levels should be measured serially until they return to safe ranges. The healthcare provider should be contacted immediately, and the patient should be managed in a facility capable of providing intensive care support.
Storage
Neoral capsules should be stored at room temperature (15-30°C or 59-86°F) in their original container, protected from moisture and light. The oral solution should be stored at room temperature and used within two months after opening. Do not freeze the medication. Keep all medications out of reach of children and pets. Do not transfer capsules to other containers, as this may affect stability. Check expiration dates regularly and properly dispose of expired medication.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions must be made by qualified healthcare professionals based on individual patient circumstances. The prescribing physician should be consulted for specific dosage recommendations and monitoring parameters. Patients should not adjust their medication regimen without professional guidance. While every effort has been made to ensure accuracy, prescribing information may change, and the most current manufacturer’s prescribing information should be consulted.
Reviews
Clinical studies demonstrate Neoral’s efficacy in transplant medicine. A comprehensive meta-analysis of kidney transplant recipients showed significantly reduced acute rejection rates compared to conventional cyclosporine (p<0.01). The consistent bioavailability profile received particular praise in hepatology literature, with one study noting “superior predictability of blood levels” (Journal of Hepatology, 2018). Transplant surgeons appreciate the flexible dosing options, though many emphasize the necessity of rigorous therapeutic drug monitoring.
Long-term outcome studies indicate 5-year graft survival rates of 75-85% in renal transplant patients maintained on Neoral-based regimens. The microemulsion technology is frequently cited as a significant advancement over previous formulations, particularly regarding dose linearity and food effect minimization. Some reviews note the challenging side effect profile but acknowledge the favorable risk-benefit ratio in transplant settings. Ongoing research continues to refine optimal trough level targets for different patient populations.