Neoral (Ciclosporin)
Complete patient guide for uses, dosage, side effects, and safety information
Prescription RequiredQuick Facts
What Is Neoral Used For?
Neoral contains ciclosporin, which belongs to a group of medicines called immunosuppressive agents. These medicines help control your body’s immune system to prevent it from attacking healthy tissue.
Primary Uses
Neoral is used to prevent organ rejection in people who have had kidney, liver, or heart transplants. It’s also used to treat severe immune system disorders including nephrotic syndrome (kidney disease), severe active rheumatoid arthritis (joint disease with pain, swelling and stiffness), severe psoriasis (skin disease causing rash with itchy scaly patches), and severe atopic dermatitis (skin disease causing dry, itchy and inflamed skin).
How It Works
Neoral works by blocking the development of special immune cells that would normally attack transplanted tissue or cause problems in autoimmune conditions.
How to Take Neoral
Your doctor will determine the correct dose based on your weight, condition, how well the medicine works for you, and any side effects you experience. Take Neoral exactly as prescribed by your doctor.
Dosage Instructions
Take Neoral in the morning and at night. For capsules: swallow whole with a full glass of water – do not chew them. Remove from foil pack only when ready to take. For oral solution: use the provided syringes to measure your dose (1-mL syringe for doses ≤1 mL, 4-mL syringe for doses >1 mL up to 4 mL). Mix the dose in a glass container with orange juice, apple juice, or soft drink – never use grapefruit juice or plastic containers. Stir well and drink immediately, then rinse the container with more liquid to ensure you get the full dose.
Important: Do not stop treatment unless your doctor tells you to. Avoid taking with grapefruit, grapefruit juice, or fatty meals as this may cause unwanted side effects.
Available Tablet Strengths
Side Effects
Like all medications, this medicine can cause side effects. Most are mild and temporary, but some require medical attention.
Common Side Effects
These side effects occur relatively frequently and usually don’t require emergency care:
- Fever
- Swelling in hands or feet
- Feeling more tired than normal
- Headache
- Dizziness
- Confusion
- Tingling or numbness
- Burning sensation in hands and feet
- Tremor or shaking
- Loss of appetite
- Swelling of the gums
- Feeling sick or vomiting
- Diarrhea
- Stomach pain or discomfort
- Excessive hair growth (especially in women)
- Acne
- Skin rash
- Flushing of the face
- Painful or absent menstrual periods
- Increased breast size in males
- Muscle cramps
- Muscle pain or tenderness
Seek immediate medical attention if you experience:
- Sudden swelling of face, lips, tongue, or throat; difficulty breathing; rash or hives; feeling faint or dizzy
- High fever, chills, feeling very unwell, confusion, rapid heartbeat, trouble breathing
- Unusual bruising or bleeding, frequent infections, extreme tiredness or weakness
- Severe headache, sudden confusion, trouble seeing, hallucinations, difficulty speaking, seizures
- Severe stomach pain, swelling of stomach area, vomiting blood, black or bloody stools, yellowing of skin or eyes
- Yellowing of skin or eyes, dark urine, severe tiredness, pain in upper right side of stomach
- Muscle cramps, weakness, confusion, irregular heartbeat, fainting, seizures
- Aching muscles, muscle tenderness or weakness not caused by exercise
- Little or no urine, bloody or smelly urine
- New lumps or moles, or changes to existing moles
Important Warnings
Neoral can cause serious side effects and requires careful monitoring. It’s important to understand the risks before starting treatment.
Who Should Not Take Neoral
Do not take Neoral if you are allergic to ciclosporin or any ingredients. For non-transplant conditions, do not use if you have uncontrolled high blood pressure or any uncontrolled infection. Do not give to patients under 16 years for rheumatoid arthritis, psoriasis, or atopic dermatitis (though it can be used in children under 16 for organ transplants or nephrotic syndrome).
Medical Conditions to Discuss
Tell your doctor if you have kidney problems, any type of cancer, planned vaccinations, liver problems, or severe heart, lung, or blood vessel disease. During treatment, you may be at risk of developing certain side effects that require monitoring.
Pregnancy and Breastfeeding
There is an increased risk of problems for both mother and unborn child with Neoral use. Breastfeeding is not recommended as ciclosporin passes into breast milk and can cause serious problems for the baby.
Cancer Risk: Neoral may increase your risk of infections and certain cancers. Tell your doctor immediately if you develop any lumps anywhere on/in your body, new moles, or changes in existing moles.
Drug Interactions
Many medicines can interfere with Neoral and affect how it works. Always tell your doctor about all medicines, vitamins, and supplements you are taking.
Grapefruit interaction: Never take Neoral with grapefruit or grapefruit juice as this can cause dangerous side effects.
- Methotrexate (for rheumatoid arthritis)
- Antibiotics (erythromycin, clarithromycin, azithromycin, rifampicin, ciprofloxacin, trimethoprim, gentamicin, tobramycin, vancomycin)
- Antifungal medicines (fluconazole, ketoconazole, itraconazole, voriconazole, amphotericin B)
- Other immunosuppressive medicines (tacrolimus, everolimus, sirolimus, mycophenolate sodium)
- Diuretics (water tablets)
- Heart/blood pressure medicines (lercanidipine, nifedipine, amlodipine, verapamil, diltiazem, nicardipine)
- Digoxin (for heart failure)
- Statins (simvastatin, atorvastatin, pravastatin)
- Fenofibrate (for high cholesterol)
- Seizure medicines (carbamazepine, phenytoin)
- Methylprednisolone (for inflammatory diseases)
- Colchicine (for gout)
- NSAIDs (diclofenac, naproxen, indomethacin)
- Recombinant human erythropoietin
- Repaglinide (for diabetes)
- Cannabidiol (medicinal cannabis)
- Stomach acid medicines (cimetidine, ranitidine)
- Oral contraceptives (levonorgestrel, norethisterone)
- Cancer medicines (etoposide, imatinib, doxorubicin)
- Octreotide
- Metoclopramide (for nausea)
- Orlistat (for weight loss)
- St John’s wort
Alcohol & Driving
Neoral can affect your ability to drive safely and may interact with alcohol. Take precautions to ensure your safety and the safety of others.
Alcohol
Tell your doctor if you drink alcohol. Drinking alcohol while taking Neoral may lead to unwanted effects. Your doctor may ask you to limit your alcohol intake.
Driving and Operating Machinery
Be careful before driving or using machines until you know how Neoral affects you. The medicine may make you feel sleepy, dizzy, cause blurred vision, or headaches. If your child is taking Neoral, check how it affects them before they ride a bike or do activities requiring coordination and concentration.
Storage
Store Neoral properly to maintain its effectiveness. Keep 10mg capsules below 25°C and 25mg, 50mg, and 100mg capsules below 30°C. Store oral solution between 15-30°C – do not refrigerate. Throw away oral solution 2 months after opening. Keep all forms in a cool, dry place away from moisture, heat, and sunlight. Do not store in bathrooms, near sinks, in cars, or on windowsills. Keep out of reach of children.
Overdose Information
If you suspect an overdose or experience serious side effects, call your doctor straight away or go to the Emergency Department at your nearest hospital immediately. Keep the medicine packaging with you to show medical staff.
Frequently Asked Questions
The time it takes for Neoral to work varies depending on your condition and individual response. Your doctor will monitor your progress and may adjust your dose based on how well the medicine works for you.
Avoid taking Neoral with grapefruit, grapefruit juice, or fatty meals as this may cause unwanted side effects. For the oral solution, mix it with orange juice, apple juice, or soft drinks – never grapefruit juice.
No, Neoral is not addictive. However, you should not stop treatment unless your doctor tells you to, as this could lead to organ rejection or worsening of your condition.
Do not stop treatment unless your doctor tells you to. Stopping suddenly could lead to organ rejection in transplant patients or worsening of your immune system condition.
Tell your doctor if you drink alcohol. Drinking alcohol while taking Neoral may lead to unwanted effects, and your doctor may ask you to limit your alcohol intake.
Avoid grapefruit and grapefruit juice, limit sun exposure and use sunscreen, avoid large amounts of high-potassium foods, don’t have vaccinations without consulting your doctor, and take special care of your teeth and gums.
The source material doesn’t specify missed dose instructions. Contact your doctor or pharmacist for guidance on what to do if you miss a dose of Neoral.
Important Disclaimer
This information is intended for general educational purposes only and should not be considered medical advice. Always consult your healthcare provider or pharmacist before starting, stopping, or changing any medication.
If you think you may have a medical emergency, call your doctor or emergency services immediately.