Generic Neoral

Introduction

Neoral is an oral formulation of the immunosuppressant cyclosporine, primarily prescribed to prevent organ rejection after transplantation and to manage severe autoimmune skin disorders. In the United Kingdom, it is listed under the skin‑care and arthritis medication groups because of its utility in conditions such as psoriasis and severe rheumatoid arthritis. The product is manufactured by Novartis (the original developer of the microemulsion formulation) and is regulated by the MHRA.

What is Neoral?

Neoral is a soft‑gel capsule containing cyclosporine in a microemulsion vehicle that enhances oral absorption. It belongs to the class of calcineurin inhibitors, a group of drugs that modulate T‑cell activity. The brand is widely recognised in transplant medicine and dermatology. While Neoral is a brand‑name product, generic cyclosporine capsules are also available; they contain the same active ingredient and are bio‑equivalent. Our online pharmacy supplies both the branded formulation and certified generic equivalents, offering a cost‑effective alternative for patients who meet clinical criteria.

How Neoral Works

Cyclosporine binds to cyclophilin, a cytosolic protein present in lymphocytes. This complex inhibits calcineurin, an enzyme essential for activating the transcription factor NF‑κB. By blocking NF‑κB, the drug reduces interleukin‑2 (IL‑2) production, suppressing the proliferation and activation of T‑cells. The resulting immunosuppression prevents the immune system from attacking transplanted tissue and diminishes the inflammatory cascade in autoimmune skin disease.

Oral absorption of the microemulsion formulation is rapid, with peak plasma concentrations typically occurring 1.5–4 hours after ingestion. The drug has a long terminal half‑life of 6–27 hours, allowing once‑ or twice‑daily dosing. Cyclosporine is extensively metabolised by CYP3A4 in the liver and intestines, and its clearance can be altered by many concomitant medicines.

Conditions Treated with Neoral

• Renal transplantation – maintains graft function by suppressing host immune response. Approximately 4,300 kidney transplants are performed annually in the UK; long‑term graft survival is closely linked to optimal cyclosporine dosing.
• Liver transplantation – used as part of a multidrug regimen to prevent acute rejection.
• Heart and lung transplantation – indicated when a calcineurin inhibitor is required.
• Severe plaque psoriasis – indicated for patients who have failed topical therapy and systemic agents such as methotrexate. Cyclosporine can achieve rapid skin clearance within 8–12 weeks.
• Rheumatoid arthritis (RA) refractory to conventional disease‑modifying antirheumatic drugs (DMARDs) – employed as a short‑term bridge therapy while waiting for biologic agents to take effect.

These indications are supported by UK NICE guidance and the MHRA’s product licence.

Who is Neoral For?

• Adult transplant recipients who require a calcineurin inhibitor as part of a maintenance immunosuppression protocol.
• Patients with moderate‑to‑severe plaque psoriasis who have not responded adequately to first‑line systemic treatments.
• Individuals with active rheumatoid arthritis who need rapid disease control pending biologic therapy.

Neoral is not suitable for:

• Patients with uncontrolled hypertension, uncontrolled hyperlipidaemia, or active infections (e.g., hepatitis B/C, HIV).
• Pregnant or lactating women, unless the benefit outweighs the risk and under specialist supervision.
• Individuals with known hypersensitivity to cyclosporine or any excipients in the soft‑gel capsule.

Risks, Side Effects, and Interactions

Common

• Nephrotoxicity – rise in serum creatinine; regular renal function monitoring is essential.
• Hypertension – may require antihypertensive therapy.
• Tremor – dose‑related, usually mild.
• Gingival hyperplasia – overgrowth of gum tissue, managed with oral hygiene and dose adjustment.
• Hirsutism – excess hair growth, more common in women.

Rare

• Hyperlipidaemia – elevation of LDL and triglycerides; lipid profile monitoring recommended.
• Neurotoxicity – seizures or posterior reversible encephalopathy syndrome (PRES) in high‑dose regimens.
• Hepatotoxicity – increased liver enzymes; monitor hepatic function periodically.

Serious

• Severe nephrotoxicity leading to renal failure, particularly when combined with other nephrotoxic agents (e.g., aminoglycosides).
• Malignancies – increased risk of squamous cell carcinoma and lymphoproliferative disorders with long‑term use.
• Severe infections – opportunistic infections such as cytomegalovirus (CMV) or fungal disease.

Clinically Relevant Interactions

• CYP3A4 inhibitors (e.g., ketoconazole, erythromycin, grapefruit juice) raise cyclosporine levels → risk of toxicity.
• CYP3A4 inducers (e.g., rifampicin, carbamazepine, St. John’s wort) lower cyclosporine concentrations → risk of graft rejection.
• Other nephrotoxic drugs (e.g., NSAIDs, tacrolimus) increase renal adverse effects.
• Vaccines – live attenuated vaccines should be avoided due to immunosuppression.

Patients must inform their healthcare professional of all medicines, herbal products, and supplements before initiating Neoral.

Practical Use: Dosing, Missed Dose, Overdose

• Standard dosing for renal transplantation: 5 mg/kg/day divided into two doses, adjusted to maintain trough blood concentrations of 100–200 ng/mL (early phase) and 50–150 ng/mL (maintenance). For psoriasis, the initial dose is often 2.5–5 mg/kg/day for up to 12 weeks, then tapered.
• Missed dose – take the missed capsule as soon as remembered if it is within 6 hours of the scheduled time; otherwise skip it and resume the regular schedule. Do not double‑dose.
• Overdose – seek urgent medical attention. Symptoms may include severe tremor, vomiting, hypertension, and renal impairment. Treatment is supportive; plasma exchange may be considered in extreme cases.
• Food and alcohol – Cyclosporine absorption is not markedly affected by meals, but high‑fat meals can delay peak levels. Alcohol may exacerbate hypertension; moderation is advised.
• Comorbidities – patients with hepatic impairment may require dose reduction; elderly patients often need closer therapeutic drug monitoring due to variable clearance.

Therapeutic drug monitoring (TDM) is integral to safe and effective use; trough levels should be measured 12 hours after the last dose, before the next dose.

Buying Neoral from Our Online Pharmacy

Neoral can be purchased from our online pharmacy in the UK with a streamlined ordering process designed for discretion and reliability.

• Affordable pricing – we source Neoral and certified generic cyclosporine at near‑manufacturer cost, passing the savings to the patient.
• Verified quality – all stock comes from licensed overseas pharmacies that meet EU‑GMP standards; each batch is laboratory‑tested for potency and purity.
• Guaranteed delivery – options include 7‑day express shipping for urgent needs and regular airmail (approximately 3 weeks) for routine orders, both packaged discreetly.
• Online‑only access – our pharmacy broker service works with international licensed suppliers, enabling patients who face limited availability or high local prices to obtain the medication safely.
• Privacy‑focused – packaging contains no branding, and personal data is handled in compliance with GDPR.

Our service provides a safe, cost‑effective route for adults who have a valid prescription from a UK‑registered clinician and need continuous supply of Neoral.

FAQ

• Is Neoral approved for use in adult organ‑transplant patients only, or can it be prescribed for skin conditions as well?
  Yes, Neoral is licensed for both transplant prophylaxis and for severe plaque psoriasis that has not responded to conventional systemic therapies. The indication depends on the prescribing clinician’s assessment and the patient’s clinical profile.

• Can Neoral be stored at temperatures above room temperature, such as in a hot car?
  No. Neoral should be kept at controlled room temperature (15–30 °C). Exposure to high heat may degrade the microemulsion, reducing its bioavailability.

• What does the soft‑gel capsule of Neoral look like, and does its appearance differ from generic cyclosporine capsules?
  Neoral capsules are opaque, gelatinised soft‑gel capsules, typically orange‑brown in colour and size .5 mL. Generic cyclosporine capsules may differ in colour, size, or shell material, but they contain the same amount of active drug.

• Are there any special considerations for travelling abroad with Neoral?
  When travelling, keep the medication in its original packaging with the label intact, and carry a copy of the prescription. Declare the medication at customs if required by the destination country, and avoid exposing it to extreme temperatures.

• How does the bioequivalence of generic cyclosporine compare with Neoral’s microemulsion formulation?
  Generic cyclosporine capsules must meet strict bioequivalence criteria set by the EMA, demonstrating that the rate and extent of absorption fall within 80–125 % of the reference product. Clinical studies have shown comparable efficacy and safety when monitored with therapeutic drug levels.

• Can Neoral be taken with grapefruit juice, or does it affect drug levels?
  Grapefruit juice strongly inhibits CYP3A4, the enzyme responsible for cyclosporine metabolism, leading to increased blood concentrations and a higher risk of toxicity. Patients should avoid large quantities of grapefruit juice while on Neoral.

• What are the regulatory requirements for importing Neoral for personal use into the UK?
  Individuals may import a three‑month supply of prescription‑only medicines for personal use under the UK’s “personal importation” scheme, provided they have a valid UK prescription and the product is authorised in the EU/UK. Our online pharmacy assists with documentation to meet these conditions.

• Does Neoral have any known interactions with common over‑the‑counter supplements such as St John’s wort?
  Yes. St John’s wort is a potent CYP3A4 inducer and can reduce cyclosporine concentrations, potentially leading to loss of graft protection or disease control. Patients should discuss all supplements with their healthcare provider.

• What monitoring schedule is recommended after initiating Neoral therapy?
  Baseline tests should include renal function, liver enzymes, blood pressure, lipids, and cyclosporine trough level. Follow‑up testing is typically performed weekly for the first month, then every 2–4 weeks until stable, and subsequently every 3–6 months, or sooner if clinical changes occur.

• Are there any differences in formulation between Neoral sold in the EU versus other regions?
  The EU formulation is a microemulsion soft‑gel capsule designed to optimise absorption. In some regions, the product may be marketed as a hard‑tablet generic with different excipients. Despite formulation differences, therapeutic drug monitoring ensures equivalent clinical effect.

Glossary

Calcineurin inhibitor

A class of drugs that block the activity of calcineurin, an enzyme crucial for T‑cell activation, thereby suppressing the immune response.

Therapeutic drug monitoring (TDM)

The clinical practice of measuring specific drug concentrations in the blood at designated intervals to maintain a constant plasma level within a target therapeutic window.

Microemulsion

A thermodynamically stable mixture of oil, water, and surfactant that enhances the solubility and oral absorption of lipophilic drugs such as cyclosporine.

Nephrotoxicity

Toxic damage to the kidneys caused by a substance, manifested by impaired renal function and elevated serum creatinine.

⚠️ Disclaimer

The information provided about Neoral is for general knowledge only. It does not replace professional medical consultation. All treatment decisions should be made under the supervision of a qualified healthcare provider. We assume all readers are responsible adults capable of making informed decisions about their health. Our online pharmacy offers access to Neoral for individuals who may have limited availability through traditional pharmacies, prescription‑based insurance schemes, or who are seeking affordable generic alternatives. Always consult your doctor before starting, changing, or discontinuing any medication.