Class: Anti-inflammatory Agents, Miscellaneous
VA Class: IM600
Chemical Name: Cyclo[[(E) - (2S,3R,4R) - 3 - hydroxy - 4 - methyl - 2 - (methylamino) - 6 - octenoyl] - l - 2 - aminobutyryl - N - methylglycyl - N - methyl - l - leucyl - l - valyl - N - methyl - l - leucyl - l - alanyl - d - alanyl - N - methyl - l - leucyl - N - methyl - l - leucyl - N - methyl - l - valyl]
CAS Number: 59865-13-3
Brands: Restasis
Introduction
Topical immunomodulator; systemic immunosuppressive agent.1 2 3 5 6 7 8 10
Uses for Cyclosporine
Keratoconjunctivitis Sicca
Used to increase tear production in adults whose tear production presumably is suppressed secondary to ocular inflammation related to keratoconjunctivitis sicca.1
Increased tear production not observed in patients already receiving topical anti-inflammatory agents or using punctal plugs.1
Cyclosporine Dosage and Administration
Administration
For ophthalmic use only.1 Not for injection.1 Not for subconjunctival injection or introduction directly into the anterior chamber of the eye.1 4
Ophthalmic Administration
Apply topically to the eye as an ophthalmic emulsion.1
Avoid contamination of emulsion container.1
Invert unit-dose vial a few times before use to obtain a uniform, opaque, white emulsion.1
Preservative-free emulsion is for single use only in one or both eyes; discard any unused portion immediately after administration.1
Remove contact lenses prior to administration; may reinsert lenses 15 minutes after dose.1
When used concomitantly with artificial tears, administer ophthalmic preparations at least 15 minutes apart.1
Dosage
Adults
Keratoconjunctivitis Sicca
Ophthalmic
1 drop of a 0.05% emulsion into each eye twice daily, approximately 12 hours apart.1
Cautions for Cyclosporine
Contraindications
Known hypersensitivity to cyclosporine or any ingredient in the formulation.1
Active ocular infections.1
Warnings/Precautions
Warnings
Safety and efficacy not established in patients with history of herpes keratitis.1
Specific Populations
Pregnancy
Category C.1
Lactation
Distributed into milk after systemic administration; it is not known whether distributed into milk after topical application to the eye.1 Caution advised if used in nursing women.1
Pediatric Use
Safety and efficacy not established in children <16 years of age.1
Geriatric Use
No substantial differences in safety and efficacy relative to younger adults.1
Common Adverse Effects
Ocular burning, conjunctival hyperemia, discharge, epiphora, ocular pain, foreign body sensation, pruritus, stinging, visual disturbance (e.g., blurring).1
Interactions for Cyclosporine
No formal drug interaction studies to date.9
Cyclosporine Pharmacokinetics
Absorption
Bioavailability
Blood cyclosporin A concentrations were below quantitation limit (0.1 ng/mL) after topical application of cyclosporine 0.05% emulsion to the eye twice daily for up to 12 months.1 7 No detectable drug accumulation in blood during 12 months of treatment.1 7
Distribution
Extent
Not known whether distributed into milk after topical application to the eye.1
Stability
Storage
Ophthalmic
Emulsion
15–25°C.1
ActionsActions
Exact mechanism of action not fully elucidated, but thought to act as a partial immunomodulator with anti-inflammatory effects when administered topically to the eye.1 2 3 5 6 7 8 10
Topical application to the eye reduces cell-mediated inflammatory responses associated with inflammatory ocular surface diseases.2 3
Exhibits immunosuppressive activity when administered systemically.1
Advice to Patients
Importance of learning and adhering to proper administration techniques to avoid contamination of the product.1
Importance of administering ophthalmic emulsion immediately after opening single-use vial and discarding any unused portion immediately after administration.1
Importance of not wearing contact lenses in presence of decreased tear production.1 If contact lenses are worn, importance of removing lenses prior to administration and delaying reinsertion of lenses for 15 minutes after instillation.1
Importance of women informing clinicians if they are or plan to become pregnant or to breast-feed.1
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1
If using artificial tears and ophthalmic cyclosporine, importance of allowing at least 15 minutes to elapse between administration.1
Importance of informing patients of other important precautionary information.1 (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Ophthalmic | Emulsion | 0.05% | Restasis (preservative-free) | Allergan |
Comparative Pricing
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
Restasis 0.05% Emulsion (ALLERGAN): 30/$146.62 or 90/$411.8
Disclaimer
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.
AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions April 2010. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
References
1. Allergan, Inc. Restasis (cyclosporine) ophthalmic emulsion 0.05% prescribing information. Irvine, CA; 2002 Dec.
2. Sall K, Stevenson OD, Mundorf TK et al. Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. Ophthalmology. 2000; 107:631-9. [IDIS 453300] [PubMed 10768324]
3. Stevenson D, Tauber J, Reis BL et al. Efficacy and safety of cyclosporin A ophthalmic emulsion in the treatment of moderate-to-severe dry eye disease. A dose-ranging randomized trial. Ophthalmology. 2000; 107:967-74. [IDIS 446941] [PubMed 10811092]
4. Allergan, Inc, Irvine, CA: Personal communication.
5. Laibovitz R, Solch S, Andriano K et al. Pilot trial of cyclosporine 1% ophthalmic ointment in the treatment of keratoconjunctivitis sicca. Cornea. 1993; 12:315-23. [PubMed 8339560]
6. Tauber J, for the Cyclosporine Study Group. A dose-ranging clinical trial to assess the safety and efficacy of cyclosporine ophthalmic emulsion in patients with keratoconjunctivitis sicca. Adv Exp Med Biol. 1998; 438:969-72. [PubMed 9634996]
7. Small DS, Acheampong A, Reis B et al. Blood cyclosporin A during long-term treatment with cyclosporin A ophthalmic emulsions in patients with moderate to severe dry eye disease. J Ocul Pharmacol Ther. 2002; 18:411-8. [PubMed 12419092]
8. Kunert KS, Tisdale AS, Gipson IK. Goblet cell numbers and epithelial proliferation in the conjunctiva of patients with dry eye syndrome treated with cyclosporine. Arch Ophthalmol. 2002; 120:330-7. [IDIS 478231] [PubMed 11879137]
9. Allergan, Inc. Restasis (cyclosporine ophthalmic emulsion) 0.05% formulary kit. Irvine, CA; 2003.
10. Anon. Ophthalmic cyclosporine (Restasis) for dry eye disease. Med Lett Drugs Ther. 2003; 45:42-3. [PubMed 12766701]
More Cyclosporine eent resources
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