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Cyclosporine (Systemic)

Prescription
Calcineurin Inhibitor / Immunosuppressant
Last reviewed 21 Apr 2026 · PetCare.AI Editorial Team
Species
Dog, Cat
Brands
3 available
Interactions
15 documented
Formulations
2

Mechanism of action

Binds cyclophilin forming a complex that inhibits calcineurin phosphatase, blocking IL-2 transcription and T-lymphocyte activation. Suppresses cell-mediated immunity without significant myelosuppression.

At a glance

Class
Calcineurin Inhibitor / Immunosuppressant
Schedule
Prescription
Storage
Store at room temperature; oral solution use within 2 months after opening; do not refrigerate

Dosing

🐕

Dog

FDA-approved (Atopica) for canine atopic dermatitis
Dose
5–10 mg/kg
Route
PO
Frequency
q24h (dermatitis) or q12h (immune-mediated)
🐈

Cat

FDA-approved for feline allergic dermatitis
Dose
7 mg/kg
Route
PO
Frequency
q24h

Formulations

💊

Other — 2

Strength
—
Strength
—

Storage

Store at room temperature; oral solution use within 2 months after opening; do not refrigerate

Safety

Monitoring parameters

GI tolerance initiallyRenal function q6 monthsCBC q6 monthsTrough levels for immune-mediated diseaseSkin response at 4–6 weeks

Interactions

Major — 5

Phenobarbital
major
Phenobarbital potently induces CYP3A4, dramatically reducing cyclosporine levels (50-75% decrease), potentially causing therapeutic failure.
Management: Increase cyclosporine dose or consider alternative anticonvulsant. Monitor cyclosporine trough levels closely.
Rifampicin
major
Rifampicin is the most potent known CYP3A4 inducer, reducing cyclosporine plasma levels by 50-90% within days, causing therapeutic failure and transplant rejection or immune-mediated disease flare.
Management: Avoid combination. If essential, increase cyclosporine dose 2-5 fold and monitor trough levels closely. Consider alternative antibiotic.
Clarithromycin
major
Clarithromycin potently inhibits CYP3A4, increasing cyclosporine levels 2-3 fold. More potent CYP inhibitor than azithromycin.
Management: Avoid if possible. If needed, reduce cyclosporine dose by 50% and monitor trough levels closely.
Posaconazole
major
Posaconazole potently inhibits CYP3A4, increasing cyclosporine levels 2-4 fold.
Management: Reduce cyclosporine dose by 50-75%. Monitor trough levels closely.
Voriconazole
major
Voriconazole potently inhibits CYP3A4, increasing cyclosporine levels 2-3 fold.
Management: Reduce cyclosporine dose by 50%. Monitor trough levels closely.

Moderate — 8

Ketoconazole (Systemic)
moderate
Ketoconazole potently inhibits CYP3A4 and P-glycoprotein, increasing cyclosporine levels 2-3 fold. Used therapeutically to reduce cyclosporine cost.
Management: When intentional: reduce cyclosporine dose by 50-75% and monitor trough levels. When unintentional: monitor for cyclosporine toxicity (vomiting, nephrotoxicity).
Meloxicam
moderate
Both cyclosporine and NSAIDs reduce renal blood flow via different mechanisms. Combined use increases nephrotoxicity risk.
Management: Monitor renal function closely. Ensure adequate hydration. Use lowest effective NSAID dose.
Itraconazole
moderate
Itraconazole inhibits CYP3A4 and P-glycoprotein, increasing cyclosporine levels (similar to ketoconazole but less potent).
Management: Reduce cyclosporine dose by 25-50%. Monitor cyclosporine trough levels.
Fluconazole
moderate
Fluconazole inhibits CYP3A4 (less potent than ketoconazole/itraconazole), increasing cyclosporine levels ~50%.
Management: Monitor cyclosporine levels. May need modest dose reduction.
Digoxin
moderate
Cyclosporine may increase digoxin levels via P-glycoprotein inhibition, reducing digoxin renal clearance.
Management: Monitor digoxin levels when adding cyclosporine.
Azithromycin
moderate
Azithromycin inhibits P-glycoprotein, potentially increasing cyclosporine levels. Less CYP3A4 inhibition than erythromycin or clarithromycin, but P-gp effect is relevant.
Management: Monitor cyclosporine levels if high-dose or prolonged azithromycin course. Usually clinically modest interaction.
Cannabidiol (CBD)
moderate
CBD inhibits CYP3A4 and P-glycoprotein, potentially increasing cyclosporine levels.
Management: Monitor cyclosporine levels when adding CBD. May need cyclosporine dose reduction.
Metoclopramide
moderate
Metoclopramide increases GI motility, potentially increasing cyclosporine absorption rate and peak levels.
Management: Monitor cyclosporine levels if metoclopramide added. Usually clinically modest effect.

Minor — 2

Enrofloxacin
minor
Enrofloxacin may modestly inhibit CYP3A4, slightly increasing cyclosporine levels. Clinical significance is minor compared to ketoconazole/itraconazole interaction.
Management: Usually clinically insignificant. Monitor cyclosporine levels if using high-dose enrofloxacin for prolonged courses.
Prednisolone
minor
Prednisolone may reduce cyclosporine clearance modestly. Both immunosuppressive — additive immune suppression. Intentionally used combination.
Management: Standard combination for IMHA and immune-mediated disease. Monitor for infection.

Brands

Other markets

Atopica
Neoral
Sandimmune

FAQs

Frequently asked questions

›What is Cyclosporine (Systemic)?
Cyclosporine (Systemic) is a calcineurin inhibitor / immunosuppressant used in pets. Binds cyclophilin forming a complex that inhibits calcineurin phosphatase, blocking IL-2 transcription and T-lymphocyte activation. Suppresses cell-mediated immunity without significant myelosuppression.
›What is Cyclosporine (Systemic) used for in pets?
Cyclosporine (Systemic) is used in veterinary medicine for: FDA-approved (Atopica) for canine atopic dermatitis; FDA-approved for feline allergic dermatitis.
›What is the Cyclosporine (Systemic) dose for dogs?
For dogs, Cyclosporine (Systemic) is typically dosed as follows — FDA-approved (Atopica) for canine atopic dermatitis: 5–10 mg/kg PO q24h (dermatitis) or q12h (immune-mediated). Always consult your veterinarian for a dose tailored to your pet's weight, age, and condition.
›What is the Cyclosporine (Systemic) dose for cats?
For cats, Cyclosporine (Systemic) is typically dosed as follows — FDA-approved for feline allergic dermatitis: 7 mg/kg PO q24h. Always consult your veterinarian for a dose tailored to your pet's weight, age, and condition.
›Does Cyclosporine (Systemic) need a prescription?
Yes. Cyclosporine (Systemic) is a prescription medication and should only be administered under veterinary supervision.

References

References

Textbooks & handbooks

  • Plumb, D.C. Plumb's Veterinary Drug Handbook. 10th ed., Wiley-Blackwell, 2023.
  • Vail, D.M., Thamm, D.H., & Liptak, J.M. (eds.). Withrow & MacEwen's Small Animal Clinical Oncology. 6th ed., Saunders/Elsevier, 2020.
  • Riviere, J.E., & Papich, M.G. (eds.). Veterinary Pharmacology and Therapeutics. 10th ed., Wiley-Blackwell, 2018.
  • National Research Council. Nutrient Requirements of Dogs and Cats. National Academies Press, Washington DC, 2006.
  • The Merck Veterinary Manual. Merck & Co., Online edition. https://www.merckvetmanual.com/

Clinical guidelines & consensus

  • Fletcher, D.J., Boller, M., Brainard, B.M., et al. "RECOVER Evidence and Knowledge Gap Analysis on Veterinary CPR." Journal of Veterinary Emergency and Critical Care, 2012;22(S1):S102–S131.
  • American Animal Hospital Association. 2018 AAHA Diabetes Management Guidelines for Dogs and Cats. AAHA Press.

Journals & peer-reviewed studies

  • Hogan, D.F., Fox, P.R., Jacob, K., et al. "Secondary prevention of cardiogenic arterial thromboembolism in the cat: The FAT CAT study." Journal of Veterinary Cardiology, 2015;17(Suppl 1):S306–S317.
  • Boswood, A., Häggström, J., Gordon, S.G., et al. "Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly: The EPIC Study — A Randomized Clinical Trial." Journal of Veterinary Internal Medicine, 2016;30(6):1765–1779.
  • ASPCA Animal Poison Control Center. Toxicology and Poison Management Guidelines. American Society for the Prevention of Cruelty to Animals. https://www.aspca.org/pet-care/animal-poison-control

Regulatory & approvals

  • Central Drugs Standard Control Organisation (CDSCO), Government of India. Veterinary Drug Approval Registry, 1969–2026. Directorate General of Health Services. https://cdsco.gov.in/

Databases

  • Washington State University, College of Veterinary Medicine. Veterinary Clinical Pharmacology Laboratory (VCPL) — MDR1 Multidrug Sensitivity Database. https://vcpl.vetmed.wsu.edu/
Educational reference only
This information is provided for educational purposes and is not a substitute for professional veterinary advice, diagnosis, or treatment. Always consult a qualified veterinarian before administering any medication to your pet. Find a vet near you →