Cyclosporine for Dogs: A Medication to Calm Immune-Related Conditions

The immune system is important for your pup's health but very complex. In some cases, it can overreact and cause conditions such as allergies and inflammatory bowel disease. These conditions can cause pain and inflammation.

If your dog has such an immune-related condition, cyclosporine (Atopica, Optimmune) is a commonly prescribed medication. Here's what you need to know if it's prescribed to your pup.

Cyclosporine for dogs at a glance

What is cyclosporine for dogs, and how does it work?

Cyclosporine helps control an overactive immune system in dogs. The immune system is important for helping the body manage inflammation and infection. But sometimes the immune system may overreact. This can lead to more inflammation, pain, and other conditions. Cyclosporine can ease symptoms caused by a pup's abnormal immune system response.

Cyclosporine comes in different forms - oral medication and eye ointment - for dogs.

What is cyclosporine used for in dogs?

Cyclosporine is used to treat several conditions in dogs.

Skin allergies

In dogs, cyclosporine can treat atopic dermatitis or atopy. Atopic dermatitis is also referred to as skin allergies in dogs and is similar to eczema in people.

The brand Atopica is FDA approved for use in dogs to treat skin allergies. When a dog has allergies, their immune system overreacts to environmental allergens. This leads to symptoms such as:

• Itchy skin

• Red skin

• Secondary bacterial and fungal infections

Dry eye

Cyclosporine is also available as an eye ointment for dogs. The brand Optimmune is FDA approved to treat keratoconjunctivitis sicca (dry eye) and chronic superficial keratitis (pannus) in dogs. In many dogs, dry eye happens when the immune system causes inflammation of tear glands.

Optimmune contains 0.2% cyclosporine. Some pets may need higher concentrations of 1% to 2% cyclosporine.

Immune-related conditions

Veterinarians prescribe cyclosporine off-label for many other immune-mediated conditions. Veterinarians may prescribe oral cyclosporine for:

• Perianal fistulas

• Immune-related blood disorders

• Inflammatory bowel disease

• Immune-related liver disease

• Other skin diseases

• Lupus erythematosus complex

• Inflammatory brain conditions

Eye conditions

Ophthalmic cyclosporine may be prescribed for:

• Chronic superficial keratitis (or pannus)

• Immune-mediated keratitis

• Eosinophilic keratitis

• Pigmentary keratitis

What is the dosage of cyclosporine for dogs, and how is it given?

The correct dosage of cyclosporine for your dog varies depending on the medication's form, your pup's medical condition, and the weight of your pet.

Oral cyclosporine dosage

The FDA-approved dosage for cyclosporine (Atopica) for allergies is 5 mg per kilogram of body weight. This is given once every 24 hours for the first 30 days. Dogs must weigh about 4 lbs to be prescribed cyclosporine.

After 30 days, the dosage may be reduced to once every other day, then twice per week until the smallest effective dose is determined. Always follow your veterinarian's advice on how to taper or reduce cyclosporine. Determining this may depend on a physical exam or lab work.

Vomiting can be common when cyclosporine is first started. Your vet may start your pup at a lower dose and increase it over time to prevent this side effect.

Veterinarians prescribe cyclosporine off-label for other medical conditions. These doses can vary. Your veterinarian should determine dosing in these cases.

Give the oral form of cyclosporine 1 hour before a meal or 2 hours following a meal.

How long your dog needs to take cyclosporine may vary depending on their condition. But in most cases, the conditions it treats need lifelong treatment to manage.

Ophthalmic cyclosporine dosage

The FDA-approved dosage for cyclosporine ophthalmic ointment (Optimmune) is ¼ strip in the affected eye(s) every 12 hours for dry eye.

It may take several weeks to see tear production respond. But discontinuing the ointment can lead to a quick relapse in the condition. Treatment for dry eye and many other immune-mediated eye conditions is lifelong.

Always follow your veterinarian's specific instructions.

What are the common side effects of cyclosporine in dogs?

Cyclosporine's side effects vary, depending on whether your dog takes the medication orally or as an eye medication. Below we look at common side effects for each type of medication.

Oral cyclosporine

The most common side effect in dogs is vomiting. You may see other signs of gastrointestinal (GI) upset. These include:

• Poor appetite

• Soft stool

• Diarrhea

GI side effects often occur when your dog starts taking the medication. These effects usually lessen over time and rarely need you to stop cyclosporine. The following may help ease these side effects:

• Giving cyclosporine with a small amount of food

• Freezing the capsules for 30 to 60 minutes before giving

• Starting with a lower dose if recommended by your vet

Less common side effects of oral cyclosporine include:

• Increased gum growth

• Blood sugar changes or diabetes

• Excessive hair growth

• Excessive shedding

• Warts

Dogs taking cyclosporine may be more likely to get a bacterial or fungal infection. This is because suppressing the immune system can lower the body's ability to fight off an infection.

Ophthalmic cyclosporine

Dogs taking cyclosporine for their eyes may experience side effects related to eye irritation. These include:

• Eye redness

• Spasming eyelids

• Fur loss around the eye

• Increased tear production

• Rubbing their eye

What are the most serious risks of cyclosporine for dogs?

The most serious risks of cyclosporine for dogs include liver toxicity and blood clots, but these are rare. Kidney toxicity can occur, but only with very high doses of cyclosporine.

Your vet may recommend checking blood work each year while your dog takes cyclosporine. This way, your vet can see if your dog's liver or kidneys have been affected.

Does cyclosporine interact with any other dog medications?

Oral cyclosporine can interact with many medications, including:

• Allopurinol

• Alprazolam (Xanax)

• Angiotensin receptor blockers, like telmisartan or losartan

• Antibiotics, such as erythromycin, enrofloxacin, and marbofloxacin

• Antidepressants, like fluvoxamine and sertraline

• Antifungals, such as fluconazole, amphotericin B, terbinafine, and ketoconazole

• Calcium channel blockers, such as diltiazem or amlodipine

• Cimetidine

• Cisapride

• Clonidine

• Colchicine

• Steroids such as prednisone

• Estrogens

• Glipizide

• Griseofulvin

• Heart medications like acetazolamide, amiodarone, digoxin, furosemide, and warfarin

• Metoclopramide

• Metronidazole

• Oclacitinib (Apoquel)

• Omeprazole

• Opioids such as fentanyl and morphine

• Phenobarbital

• Rifampin

• Sulfasalazine

It may be OK to combine cyclosporine with your dog's other medications on this list. Ask your veterinarian, and follow their guidance.

Ophthalmic cyclosporine

There are no known interactions between the eye version of cyclosporine and other medications. Cyclosporine is often used with other eye medications. These may include antibiotic and steroid eye medications and eye lubricants. Tacrolimus is another medication for dry eye. It may be used together with ophthalmic cyclosporine.

What should you do if your dog misses a dose of cyclosporine?

If you give your dog cyclosporine once a day and you miss a dose, give the next dose as soon as possible. Then continue your usual schedule, even if the next regular dose is in less than 24 hours.

For a dog that's on cyclosporine every other day or 2 to 3 times a week, give the next dose as soon as possible. Restart every 2 to 3 days after that.