WHAT IS Gengraf/Cyclosporine?

Gengraf/CYCLOSPORINE is used to decrease the immune system's response to a transplanted organ. The medicine ( Neoral only) is also used for rheumatoid arthritis and psoriasis. This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

WHAT SIDE EFFECTS MAY I NOTICE FROM Gengraf/Cyclosporine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• changes in vision
• vomiting
• seizures
• yellowing of the eyes or skin
• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• numbness or tingling in the hands and feet
• increased urge to urinate or frequent urination
• high blood pressure
• severe stomach pain

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• nausea
• tremors
• excessive hair growth on the face or body
• bleeding or tender gums, overgrowth of gum tissue
• diarrhea

This list may not describe all possible side effects.

WHAT IF I MISS A DOSE?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses. Call your doctor or health care professional if you miss more than one dose or if you miss doses on a regular basis.

WHAT SHOULD I TELL MY HEALTH CARE PROVIDERS BEFORE I TAKE Gengraf/Cyclosporine?

They need to know if you have any of these conditions:

• cancer
• high blood pressure
• pregnant or trying to get pregnant
• an unusual or allergic reaction to Gengraf/cyclosporine, alcohol, corn oil ( Neoral only), castor oil ( Neoral only), other medicines, foods, dyes, or preservatives
• breast feeding
• previous coal tar, PUVA, ultraviolet, or radiation therapy
• liver disease
• immune system problems
• infection
• kidney disease

WHAT SHOULD I WATCH FOR WHILE USING Gengraf/Cyclosporine?

This medicine can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medicine affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may interfere with the effect of this medicine. Avoid alcoholic drinks.

Visit your doctor or health care professional for regular checks on your progress. You will have regular blood checks. Do not change the brand of medicine unless directed by your doctor or health care professional.

If you get a cold or other infection while taking this medicine, call your doctor or health care professional. Do not treat yourself. The medicine may decrease your body's ability to fight infections.

The medicine can cause unusual growth of gum tissue and can make your gums bleed. Practice good oral hygiene, and be careful when brushing and flossing your teeth. See your dentist regularly.

WHERE SHOULD I KEEP Gengraf/Cyclosporine?

At a temperature below 20 degrees C (68 degrees F) some brands of cyclosporine oral solution (e.g., Neoral and its generic forms) may form a gel or sediment. If this happens, let the medicine warm to room temperature (about 77 degrees F) before use.

Keep out of the reach of children.

Store Neoral at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Store Sandimmune below 30 degrees C (86 degrees F). Do not keep in the refrigerator. Do not freeze. Keep the medicine in the original packaging. Throw away any unused medicine after two months of opening the bottle or after the expiration date.

WHAT MAY INTERACT WITH Gengraf/Cyclosporine?

Do not take this medicine with any of the following:

• mibefradil
• ranolazine
• bosentan
• St. John's wort
• red yeast rice, monascus purpureus
• cidofovir
• Prograf/tacrolimus
• cisapride

This medicine may also interact with the following:

• Parlodel/bromocriptine
• Danocrine/danazol
• Zovirax/acyclovir
• Zyloprim/allopurinol
• medicines that suppress the immune system
• voriconazole
• sirolimus
• NSAIDs, medicines for pain and inflammation, like Motrin/ibuprofen or Anaprox/naproxen
• female hormones, including contraceptive or birth control pills
• Cordarone/amiodarone
• Ticlid/ticlopidine
• melphalan
• antibiotics like Cipro/ciprofloxacin, gentamicin, tobramycin, vancomycin, trimethoprim; sulfamethoxazole, nafcillin, rifampin, rifabutin, Zithromax/azithromycin, Biaxin/clarithromycin, P.c.e/erythromycin, and quinupristin; dalfopristin
• triamterene
• imatinib
• Zantac/ranitidine
• medicines for cholesterol like Mevacor/lovastatin, Zocor/simvastatin, Lipitor/atorvastatin, and Tricor/fenofibrate
• Aldactone/spironolactone
• medicines for HIV infection like Crixivan/indinavir, Viracept/nelfinavir, Norvir/ritonavir, and saquinavir
• sulfinpyrazone
• Trileptal/oxcarbazepine
• Dilantin er/phenytoin
• Reglan/metoclopramide
• cimetidine
• steroid medicines like Meticorten/prednisone or cortisone
• vaccines
• octreotide
• phenobarbital
• medicines for fungal infections like amphotericin B, Diflucan/fluconazole, Sporanox/itraconazole, Lamisil/terbinafine, and Nizoral/ketoconazole
• colchicine
• amiloride
• Carbatrol/carbamazepine
• medicines for blood pressure like Dilacor cr/Diltiazem xl/diltiazem , nicardipine, Calan/verapamil, Vasotec/enalapril , Altace/ramipril, and losartan
• Digitek/digoxin
• Rheumatrex/methotrexate
• Xenical/orlistat

This list may not describe all possible interactions. Give your health care providers a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

HOW SHOULD I USE Gengraf/Cyclosporine?

Take this medicine by mouth. Follow the directions on the prescription label. Use the dosing syringe provided to measure your dose. For the Sandimmune brand, mix your dose in milk, chocolate milk, or orange juice (at room temperature). If you are taking any other brand of Gengraf/cyclosporine, mix the measured dose in a glass of orange or apple juice that is at room temperature. Do not use grapefruit juice or milk. Mix in a glass container (not plastic) and stir well just before taking. Rinse the glass with more liquid and swallow to make sure you get all the dose. Try to mix with the same diluent for each dose. This will help you keep a constant amount of Gengraf/cyclosporine in your body. After use, dry the outside of the dosing syringe with a clean towel. Do not rinse with water or any other cleaning agent. The dosing syringe must be dry before use. Take your medicine at regular intervals. Take it at the same time each day and at the same time in relation to meals. Do not take it more often than directed. Do not stop taking except on your doctor's advice.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed. While this drug may be prescribed for children as young as 1 year for selected conditions ( Neoral ) and for children as young as 6 months for selected conditions ( Sandimmune ), precautions do apply.

Patients over 65 years old may have a stronger reaction and need a smaller dose.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

Note: This medicine is only for you. Do not share this medicine with others.

What is the shelf life of the pills?

• The expiry date is mentioned on each blister. It is different for different batches. The shelf life is 2 years from the date of manufacture and would differ from batch to batch depending on when they were manufactured.