Cyclosporine: veterinary dose and monograph

At a glance

Drug class

Veterinary drug

Also known as

Atopica, Cyclavance, Optimmune, Neoral

Species with doses

Dogs, Cats and Horses

General dose range

3–7 mg/kg PO q24h — check the species tables for the indication

Routes

PO, Ocular

Last reviewed

1 October 2026

Indications

• Canine atopic dermatitis (FDA-approved indication for Atopica)
• Perianal fistula / anal furunculosis (German Shepherd) — primary therapy
• Immune-mediated haemolytic anaemia (IMHA) — steroid-sparing add-on
• Inflammatory bowel disease (IBD) refractory to steroid
• Keratoconjunctivitis sicca (KCS) — topical (Optimmune)
• Pemphigus, lupus, other autoimmune dermatoses
• Aplastic anaemia / red cell aplasia
• Feline asthma (alternative to inhaled steroid)

Cyclosporine dose by species

Doses are per administration unless stated. mg/kg doses scale with body weight; per-animal, per-quarter and infusion-rate doses are shown as the reference writes them.

Dogs

• Atopic dermatitis: Plumb’s p.331 (Atopica label): 5 mg/kg (3.3–6.7 mg/kg) PO once daily for 30 days, then taper to every other day and twice weekly to the lowest effective frequency; give 1 h before or 2 h after food. Papich 5e: 3–7 mg/kg/day (typically 5 mg/kg/day), later as low as 5 mg/kg every 2–3 days. With ketoconazole 5 mg/kg/day the cyclosporine dose can be roughly halved (Ihrke; White). Modified (microemulsion) formulations are not interchangeable with Sandimmune.
• Perianal fistula: Papich 5e: 5–8 mg/kg q12h for perianal fistulas, reduced once a response is seen. Plumb’s p.331 (Diesel & Moriello 2008): 5 mg/kg PO twice daily alone, or 5 mg/kg once daily with ketoconazole 8 mg/kg once daily; complete remission can take 16–20 weeks — continue 4 weeks past remission.
• IMHA / refractory autoimmune disease: Papich 5e: 5–8 mg/kg q12h for immune-mediated disease, reduced after response. Plumb’s p.331 uses less: modified cyclosporine 5–10 mg/kg/DAY divided q12h, aiming for a trough above 200 ng/mL (Macintire 2006). Monitor trough levels; ketoconazole co-administration lowers the dose needed.
• KCS (topical Optimmune): Plumb’s 10e p.1357 (Cyclosporine Ophthalmic; label dosage, FDA-approved): keratoconjunctivitis sicca and chronic superficial keratitis in dogs — ¼ inch strip to the affected eye(s) every 12 hours; tear production improves over 2–6 weeks. Other inflammatory ocular surface disease (extra-label): ointment ¼–½ inch strip q12h, or 1–2% cyclosporine solution 1 drop q12h. Papich 5e covers only the systemic drug.
• Steroid-refractory inflammatory bowel disease: Papich 5e: 5 mg/kg PO q12h, reducing to q24h after response. Plumb’s p.331 (Allenspach 2006): 5 mg/kg PO once daily.

Cats

• Allergic dermatitis: Papich 5e: 7.5 mg/kg/day PO; some cats are controlled on this dose every other day or twice weekly. Plumb’s p.331: 5–10 mg/kg PO daily for atopic dermatitis or eosinophilic granuloma complex. Asthma protocols use different products and trough-guided doses — not covered by this row.

Horses

• Recurrent uveitis (topical / sub-conjunctival implant): Not weight-dosed — delivered as a surgically placed sustained-release implant. Merck (Systemic Pharmacotherapeutics of the Eye, p.929): suprachoroidal cyclosporine implants are now the more common choice for long-term management of equine recurrent uveitis, lasting up to 3 years. A specific implant dose is not stated in the uploaded references — confirm the implant strength against the product insert and the attending ophthalmologist.

Contraindications

Hypersensitivity. Concurrent treatment with live vaccines (immunosuppression). History of malignancy (theoretical re-activation risk). Severe renal / hepatic disease (reduce dose, monitor levels). Pregnancy (limited data, generally avoided). Cats with FeLV / FIV (controversial — immunosuppression in retrovirus-positive cats).

Species-specific warnings

Dogs: GI side effects are dose-limiting — FREEZE Atopica capsule for 1 h pre-dose to reduce vomiting. Standard for atopy and perianal fistula. Skin infection surveillance at every recheck.

Cats: Cats need HIGHER mg/kg dose (~7 mg/kg) due to faster clearance. LYMPHOMA RISK on prolonged use — palpate nodes every visit. FeLV/FIV test before starting.

Horses: Used as topical / sub-conjunctival implant for equine recurrent uveitis — not systemic.

Adverse effects

• GI: vomiting, diarrhoea, anorexia (very common in dogs — give with food or freeze capsule)
• Gingival hyperplasia (chronic use)
• Papillomatosis (oral / cutaneous warts)
• Hirsutism / hypertrichosis
• Hepatotoxicity (uncommon)
• Nephrotoxicity (more relevant in humans; rare at vet doses)
• Increased susceptibility to opportunistic infection (skin, UTI)
• Cats: malignancy risk (lymphoma) on prolonged use

Drug interactions

• CYP3A4 INHIBITORS (ketoconazole, itraconazole, erythromycin, fluconazole, cimetidine): INCREASE cyclosporine levels — sometimes used INTENTIONALLY (ketoconazole 5 mg/kg + cyclosporine 2.5 mg/kg = cost savings)
• CYP3A4 INDUCERS (phenobarbital, phenytoin, rifampicin): DECREASE cyclosporine levels — may need dose increase
• NSAIDs: additive nephrotoxicity (more relevant in human medicine)
• Aminoglycosides, amphotericin B: additive nephrotoxicity
• Statins: increased rhabdomyolysis risk (rare in vet)
• Vaccines (live): immunosuppression may impair response — postpone if possible
• Glucocorticoids: synergistic immunosuppression — common combination for IMHA

Pregnancy and lactation

Crosses placenta. Limited vet data. FDA Category C (human). Generally avoided in pregnancy unless benefit outweighs risk (severe autoimmune disease).

Monitoring

• Clinical response — pruritus / lesion score at 2 weeks, 4 weeks, then monthly
• CBC, biochemistry (ALT, ALP, BUN, creatinine), urinalysis at baseline, 4 weeks, then every 3 months
• Trough cyclosporine level (refractory cases): target 100–300 ng/mL (IMHA) or 400–600 ng/mL (transplant)
• Skin infection surveillance (pyoderma, demodicosis, Malassezia overgrowth) at every recheck
• Cats: lymph node palpation at every visit; investigate any lymphadenopathy
• Gingival hyperplasia / hirsutism documented at visits
• FeLV/FIV status BEFORE starting in cats — controversial in positive cats

Toxicity and overdose

GI side effects (vomiting, anorexia) are dose-limiting in dogs — give WITH FOOD or freeze capsule. Gingival hyperplasia / hirsutism / papillomatosis on chronic use. Hepatotoxicity uncommon. Nephrotoxicity rare at vet doses. INCREASED INFECTION RISK (UTI, opportunistic skin infections, fungal). Cats: LYMPHOMA RISK on prolonged use (>1 year) — monitor closely, especially FeLV/FIV-positive cats.

Management: No specific antidote. Activated charcoal if recent ingestion. IV fluids, anti-emetic for vomiting. Discontinue or reduce dose. Hemodialysis NOT effective (highly protein-bound). Monitor renal and hepatic function. Most overdoses resolve within 1–2 weeks of discontinuation.

Clinical pearls

• GI side effects are the main limitation — FREEZE Atopica capsule for 1 h before giving (dramatically reduces vomiting in dogs)
• Ketoconazole 5 mg/kg + cyclosporine 2.5 mg/kg PO q24h = "ket-CSA" combo: ketoconazole inhibits CYP3A4, reduces cyclosporine dose 50% (cost savings)
• Atopica taper: 5 mg/kg q24h × 4 weeks → q48h × 4 weeks → q48h–q72h maintenance based on flare frequency
• Perianal fistula: cyclosporine is the medical treatment of choice (>80% response rate); reduces or eliminates need for surgery
• KCS (Optimmune): tear production usually improves by 4 weeks; long-term maintenance therapy
• IMHA: cyclosporine as steroid-sparing add-on once acute crisis controlled; goal is to taper steroid
• NEVER give live vaccines during cyclosporine therapy — risk of vaccinal disease
• Cats on long-term cyclosporine: LYMPHOMA RISK — palpate lymph nodes every visit, FeLV/FIV test before starting
• Pre-treat with anti-emetic (maropitant) for first 1–2 weeks if vomiting occurs
• Therapeutic drug monitoring not routinely needed for atopy; useful for IMHA / transplant

Mechanism of action

Cyclic peptide calcineurin inhibitor (from Tolypocladium fungus). Forms a complex with intracellular cyclophilin → binds and inhibits CALCINEURIN — a phosphatase essential for nuclear factor of activated T-cells (NFAT) dephosphorylation. Blocks NFAT nuclear translocation → blocks IL-2 transcription → blocks T-helper cell proliferation. Selectively immunosuppresses T-cell-mediated immunity while sparing innate immunity and B-cells. Does NOT cause the bone marrow suppression of azathioprine or the GI/endocrine side effects of glucocorticoids.

Formulations and products

• Atopica 10 / 25 / 50 / 100 mg capsule
• Cyclavance 100 mg/mL oral solution
• Optimmune 0.2 % ophthalmic ointment (KCS)
• Neoral / Sandimmun 100 mg/mL human microemulsion
• Atopica (Elanco) — 10 / 25 / 50 / 100 mg, Soft gel capsule
• Cyclavance (Virbac) — 100 mg/mL, Oral solution
• Optimmune (Merck Animal Health) — 0.2 %, Ophthalmic ointment
• Neoral — 25 / 100 mg, Soft gel capsule (microemulsion) (human-label)
• Sandimmun — 100 mg/mL, Oral solution (human-label)

Storage

Atopica capsules: 15–25 °C, original packaging (moisture-sensitive). Oral solution (Cyclavance, Neoral): 15–25 °C, do not refrigerate (precipitates). Optimmune ophthalmic: 15–25 °C. Discard 2 months after opening solution.

Before you use this dose

Reference doses for veterinary professionals. Confirm the dose against the product label, the patient’s condition, current guidance and local regulations before use; the attending veterinarian remains responsible for every clinical decision.

Other hormones, emergency drugs, supplements and other drugs

• Clopidogrel
• Cloprostenol
• Cyanocobalamin (Vitamin B12)
• Cyclophosphamide
• Cyproheptadine
• Dantrolene
• Deferoxamine (Desferrioxamine)
• Deslorelin

Frequently asked questions