cycloSPORINE
PrintTrade Name(s): Sandimmune; Neoral; Gengraf | |
Group 2: Non-Antineoplastic Hazardous | AHFS Class: Calcineurin Inhibitors, Miscellaneous |
Activity | Gloves | Gown | Eye/Face | Mask | Notes/Instructions |
Dispensing prepackaged formulations |
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Counting/Repackaging tablets and capsules | Recommended if pregnant, breast feeding, or trying to conceive | If risk of dust inhalation |
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Repackaging oral liquids | If risk of spill or splash | If risk of inhalation |
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Activity | Gloves | Gown | Eye/Face | Mask | Notes/Instructions |
All prepackaged formulations |
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Mixing | If risk of spill or splash | If risk of inhalation |
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Formulation | Gloves | Gown | Eye/Face | Mask | Notes/Instructions |
Tablet or capsule - from unit dose package | or Recommended if pregnant, breast feeding, or trying to conceive. |
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Liquid - oral or feeding tube | or Recommended if pregnant, breast feeding, or trying to conceive. | Recommended if pregnant, breast feeding, or trying to conceive. | If potential for splash, vomit or spit up. |
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Reference: NIOSH 2016, USP <800>
Activity | Gloves | Gown | Eye/Face | Mask |
Administration | If risk of spill or splash | If risk of inhalation |
Reference: NIOSH 2016, USP <800>
Type of Instance | Gloves | Gown | Mask | Eye/Face | Notes/Instructions |
Receiving undamaged HD shipping container |
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Receiving damaged HD shipping container | If container must be opened | If container must be opened | If container must be opened |
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Spill Cleanup | Large volume | Large volume |
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Reference: USP <800>
Hazardous Pharmaceutical | Trace Chemo | Biohazardous and Sharps |
1. Non-returnable hazardous, chemo and EPA regulated drugs. (Patient specific prescriptions, partially used blister packs, containers with more than 3% medication remaining) 2. Empty bottles or packaging of P-Listed drugs. (Warfarin, nicotine, epinephrine, nitroglycerin, physostigmine) 3. PPE with visible contamination from hazardous drug. | 1. Waste contaminated through contact with chemotherapeutic agents. (Empty vials, IV bags, syringes and tubing) 2. PPE worn while handling hazardous drugs with NO visible contamination. (Gowns, gloves and masks) 3. Used CSTD devices. | 1. All sharps capable of cutting or piercing the skin. (Needles/syringes, broken ampules, lancets) 2. Items contaminated with blood or other potentially infectious materials. (Tubing, bags or dressings containing blood, contaminated waste from isolation patients) |
Dosage Form | Ship to Institution or Pharmacy | Ship to Locations Outside of ODOC |
Tablets and Capsules |
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Liquid, Topical, and Transdermal |
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PPE | Standards |
Shoe Covers |
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Gowns |
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Gloves |
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Face Shields |
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Goggles |
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N95 Masks |
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Removal and Disposal |
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Reference: USP <800>
- Harmful if swallowed.
- May cause cancer.
- May damage fertility or the unborn child.
Reference: SDS Cayman Chemical
In a nutshell, cyclosporine is a calcineurin inhibitor and this activity allows for inhibition of T cell activation.3
Cyclosporine's pharmacological action is obtained by the binding to the intracellular receptor cyclophilin-1 which produces the complex ciclosporin-cyclophilin. This complex will in order inhibit calcineurin which will prevent the dephosphorylation and activation of the nuclear factor of activated T cells (NF-AT). The NF-AT is a transcription factor that regulates the production of pro-inflammatory cytokines such as IL-2, IL-4, interferon-gamma and TNF-alpha.3
The critical role of this inhibition cascade relies on the specific inhibition of IL-2 due to the major role of this interleukin on the activation and proliferation of T cells. On the second plane, the inhibition of NF-AT also produces a deficiency of other factors related to T helper cell differentiation, T cell tolerance, and thymocyte development. Some reports even indicate a role of NF-AT on innate immunity giving cyclosporine a regulatory activity on both innate and adaptative immune responses.3
Reference: Drug Bank