Cyclosporine is an immune suppressing compound that is made
by the fungus Beauveria nivea. It
was originally isolated in Norway in 1970. Its primary mode of action is in
inhibiting the actions of the helper T-Lymphocytes. It also affects
T-Suppressor cells, lymphokine production, inhibits release of interleukin-2
and T-Cell Growth factor. It also has some humoral immunosuppressive action.
(Plumb's Veterinary Drug Handbook Fifth Edition). In comparison to
glucocorticoids, cyclosporine is more specific and has less side effects if
used at proper dosing.
Atopica is a Novartis product and is the only FDA and EPA
approved form of cylcospoine for dogs ("The Management of
Canine Atopic Dermatitis" Canine Medicine Symposium 2009 Peter
J. Ihrke, VMD, DACVD Department of Medicine & epidemiology, School of
Veterinary Medicine, University of California, Davis, CA.) The difference from
generic cyclosporine, is that Atopica is a micro emulsified form which provides
enhanced and consistent absorption. This is a medication that the generic form
is generally recommended against as they are are not microemulsified.
What are some of the considerations of
using Atopica?
Cost. It can be fairly expensive.
It can take 4-8 weeks to begin to see
effects. Many times Atopica therapy may be dismissed as not working because a
complete trial was not performed. If an eight week course of Atopica does not
produce any effect, then the medication should be stopped.
It should be given on an empty stomach
Side
effects: Atopica uses castor oil as a medium to carry the cyclosporine.
When you give castor oil on an empty stomach, it can lead to vomiting
and sometimes diarrhea. This might be mistaken as an actual medication
reaction instead of just an intolerance to the castor oil. Overall
modified cyclosporine at the atopic recommended dose is very safe.
Cyclosporine at very high levels can have implications with kidney and
liver disease (however this can be said of many medications).
Concurrent use of Ketoconazole.
As Atopica can be expensive to maintain, sometimes a medication called Ketoconazole will be used at the same time. Ketoconazole will not only help reduce cyclosporine costs but can also keep secondary yeast and fungal infections at bay.
Cyclosporine is metabolized by cytochrome P-450 enzymes which are also used with ketoconazole, a
common antifungal. For this reason, concurrent use of ketoconazole can inhibit
the metabolism of cyclosporine. Thus sometimes for financial considerations,
ketoconazole can be added to the regimen to reduce the amount of cyclosporine
needed for therapy. As always, ask your veterinarian first.
