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Cyclosporine (Sandimmune/Neoral)

Immunosuppressantprescriptionoral · inferred

Calcineurin inhibitor immunosuppressant, historically the backbone of organ transplantation. CYP3A4 and P-glycoprotein substrate with narrow therapeutic index. Critical in preventing organ rejection post-transplant.

Projected serum levels — 200 mg, twice daily

Cyclosporine (Sandimmune/Neoral)
Cyclosporine (Sandimmune/Neoral) modeled serum levels, 200 mg twice daily over 15 days Population-based pharmacokinetic estimate. Steady state reached after approximately 2 days. 0 25 50 75 100 Day 0 Day 4 Day 7 Day 11 Day 15 Time on a regular schedule ≈ steady state · day 2
Cyclosporine (Sandimmune/Neoral) modeled serum levels with a loading dose of 327 mg, then 200 mg twice daily The first dose is larger so levels approach steady state faster. 0 25 50 75 100 Day 0 Day 4 Day 7 Day 11 Day 15 Time on a regular schedule

Maintenance schedule: 200 mg twice daily (oral).

Loading schedule: 327 mg on day 1, then 200 mg twice daily — reaching therapeutic levels sooner.

Modeled steady state after ~2 days: peak ≈ 83.3 mg, trough ≈ 37.2 mg body load. Population-based estimate over 15 days for a 200 mg dose at a 70 kg reference body mass — the interactive app scales curves to your doses, timing, and body mass.

Key facts

Category
Immunosuppressant
Route modeled
Oral
Model confidence
inferred
Half-life
8.4 h
Common dose
200 mg
Suggested maximum
800 mg/day
Reference dose range
100–800 mg (single dose)
Suggested cadence
twice daily
Validated against
300 mg oral — Cmax 1.1 mg/L at 2 h

Documented interactions

  • contraindicated
    Efavirenz (Sustiva) + Cyclosporine (Sandimmune/Neoral) CYP induction

    Efavirenz (Sustiva) inducer of CYP3A4 predicted to change Cyclosporine (Sandimmune/Neoral) AUC by ~0.15x

  • contraindicated
    Rifampin + Cyclosporine (Sandimmune/Neoral) CYP induction

    Rifampin inducer of CYP3A4 predicted to change Cyclosporine (Sandimmune/Neoral) AUC by ~0.15x

  • danger
    7-Hydroxymitragynine (7-OH) + Cyclosporine (Sandimmune/Neoral) CYP inhibition

    Cyclosporine (Sandimmune/Neoral) reversible_inhibitor of CYP3A4 predicted to change 7-Hydroxymitragynine (7-OH) AUC by ~2.20x

  • danger
    Alfuzosin (Uroxatral) + Cyclosporine (Sandimmune/Neoral) CYP inhibition

    Cyclosporine (Sandimmune/Neoral) reversible_inhibitor of CYP3A4 predicted to change Alfuzosin (Uroxatral) AUC by ~3.33x

  • danger
    Alprazolam (Xanax) + Cyclosporine (Sandimmune/Neoral) CYP inhibition

    Cyclosporine (Sandimmune/Neoral) reversible_inhibitor of CYP3A4 predicted to change Alprazolam (Xanax) AUC by ~3.33x

  • danger
    Amlodipine (Norvasc) + Cyclosporine (Sandimmune/Neoral) CYP inhibition

    Amlodipine (Norvasc) reversible_inhibitor of CYP3A4 predicted to change Cyclosporine (Sandimmune/Neoral) AUC by ~2.36x

Serum checks 399 modeled interaction pairings for cyclosporine (sandimmune/neoral) across your whole stack — absorption conflicts, enzyme inhibition, and nutrient depletion included.

Research behind this entry

  1. In renal transplantation blood cyclosporine levels soon after surgery act as a major determinant of rejection: Insights from the MY.S.S. Trial Halloran PF et al. · Kidney International, 2015 DOI

    Landmark trial: levels 300-440 ng/mL associated with lowest rejection.

  2. Cyclosporine: A Review Tedesco D et al. · Journal of Transplantation, 2012 DOI

    Comprehensive pharmacokinetics and therapeutic drug monitoring review.

  3. Early non-steady-state population pharmacokinetics of oral cyclosporine in renal transplant recipients Yates CR et al. · Clinical Pharmacokinetics, 2009 DOI

    Population PK showing high inter-individual variability.

3 published studies referenced in the app, each with a plain-language summary.