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Generic Gengraf Cyclosporine 25/100mg

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. Gengraf (cyclosporine oral solution, USP [MODIFIED]) has increased bioavailability in comparison to Sandimmune. Gengraf and Sandimmune are not bioequivalent and cannot be used interchangeably without physician supervision. The daily dose of Gengraf (cyclosporine oral solution, USP should always be given in two divided doses (BID). Do not take this medicine with any of the following:bosentan , cidofovir , cisapride , mibefradil , ranolazine , red yeast rice, monascus purpureus , St. John's wort , tacrolimus .This

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Warnings

It is not clear whether the risk with cyclosporine is greater than that in Rheumatoid Arthritis patients or in Rheumatoid Arthritis patients on cytotoxic treatment for this indication. Five cases of lymphoma were detected: four in a survey of approximately 2,300 patients treated with cyclosporine for rheumatoid arthritis, and another case of lymphoma was reported in a clinical trial. Although other tumors (12 skin cancers, 24 solid tumors of diverse types, and 1 multiple myeloma) were also reported in this survey, epidemiologic analyses did not support a relationship to cyclosporine other than for malignant lymphomas.

Gengraf Adverse Reactions

Compounds that decrease cyclosporine absorption such as orlistat should be avoided. Cyclosporine is extensively metabolized by cytochrome P-450 III-A. Preliminary data indicate that when methotrexate and cyclosporine were coadministered to rheumatoid arthritis patients (N = 20), methotrexate concentrations (AUCs) were increased approximately 30% and the concentrations (AUCs) of its metabolite, 7-hydroxy methotrexate, were decreased by approximately 80%. The clinical significance of this interaction is not known.

Gengraf Drug Interactions

Substances that inhibit this enzyme could decrease metabolism and increase cyclosporine concentrations. Although concomitant administration of diclofenac does not affect blood levels of cyclosporine, it has been associated with approximate doubling of diclofenac blood levels and occasional reports of reversible decreases in renal function. Substances that are inducers of cytochrome P-450 activity could increase metabolism and decrease cyclosporine concentrations. Clinical status and serum creatinine should be closely monitored when cyclosporine is used with nonsteroidal anti-inflammatory agents in rheumatoid arthritis patients Pharmacodynamic interactions have been reported to occur between cyclosporine and both naproxen and sulindac, in that concomitant use is associated with additive decreases in renal function, as determined by Tc-diethylenetriaminepentaacetic acid (DTPA) and (p-aminohippuric acid) PAH clearances.