Description and Brand Names

Drug information provided by: Merative, Micromedex®

US Brand Name

1. Lupkynis

Descriptions

Voclosporin is used to treat active lupus nephritis. It is a calcineurin inhibitor that changes the immune system to help control lupus symptoms.

This medicine is available only with your doctor's prescription.

This product is available in the following dosage forms:

• Capsule, Liquid Filled

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of voclosporin in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of voclosporin in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving voclosporin.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Bepridil
• Boceprevir
• Cisapride
• Clarithromycin
• Cobicistat
• Conivaptan
• Dronedarone
• Fluconazole
• Idelalisib
• Indinavir
• Itraconazole
• Ketoconazole
• Levoketoconazole
• Lopinavir
• Mesoridazine
• Nefazodone
• Nelfinavir
• Pimozide
• Piperaquine
• Posaconazole
• Ritonavir
• Saquinavir
• Sparfloxacin
• Telaprevir
• Telithromycin
• Terfenadine
• Thioridazine
• Voriconazole
• Ziprasidone

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Adagrasib
• Adenovirus Vaccine, Live
• Alfuzosin
• Amiodarone
• Amisulpride
• Amitriptyline
• Anagrelide
• Apalutamide
• Apomorphine
• Aprepitant
• Aripiprazole
• Aripiprazole Lauroxil
• Arsenic Trioxide
• Asenapine
• Astemizole
• Atazanavir
• Azithromycin
• Bacillus of Calmette and Guerin Vaccine, Live
• Bedaquiline
• Bosentan
• Buprenorphine
• Buserelin
• Carbamazepine
• Cenobamate
• Ceritinib
• Chloroquine
• Chlorpromazine
• Cholera Vaccine, Live
• Ciprofloxacin
• Citalopram
• Clofazimine
• Clomipramine
• Clothiapine
• Clozapine
• Crizotinib
• Cyclobenzaprine
• Cyclosporine
• Dabrafenib
• Dasatinib
• Degarelix
• Delamanid
• Dengue Tetravalent Vaccine, Live
• Desipramine
• Deslorelin
• Deutetrabenazine
• Dexmedetomidine
• Digoxin
• Diltiazem
• Disopyramide
• Dofetilide
• Dolasetron
• Domperidone
• Donepezil
• Doxepin
• Droperidol
• Duvelisib
• Ebastine
• Ebola Zaire Vaccine, Live
• Efavirenz
• Encorafenib
• Entrectinib
• Enzalutamide
• Eribulin
• Erythromycin
• Escitalopram
• Etrasimod
• Etravirine
• Famotidine
• Fedratinib
• Felbamate
• Fexinidazole
• Fingolimod
• Flecainide
• Fluoxetine
• Fluvoxamine
• Formoterol
• Foscarnet
• Fosnetupitant
• Fosphenytoin
• Galantamine
• Gatifloxacin
• Gemifloxacin
• Gepirone
• Glasdegib
• Gonadorelin
• Goserelin
• Granisetron
• Halofantrine
• Haloperidol
• Histrelin
• Hydroquinidine
• Hydroxychloroquine
• Hydroxyzine
• Ibutilide
• Iloperidone
• Imatinib
• Imipramine
• Influenza Virus Vaccine, Live
• Inotuzumab Ozogamicin
• Ivabradine
• Ivosidenib
• Lapatinib
• Larotrectinib
• Lenacapavir
• Lenvatinib
• Letermovir
• Leuprolide
• Levofloxacin
• Lofexidine
• Lorlatinib
• Lumacaftor
• Lumefantrine
• Macimorelin
• Mavacamten
• Measles Virus Vaccine, Live
• Mefloquine
• Methadone
• Methotrimeprazine
• Metronidazole
• Mifepristone
• Mitotane
• Mizolastine
• Mobocertinib
• Modafinil
• Moricizine
• Moxifloxacin
• Mumps Virus Vaccine, Live
• Nafarelin
• Nafcillin
• Netupitant
• Nilotinib
• Norfloxacin
• Octreotide
• Ofloxacin
• Olanzapine
• Olutasidenib
• Omaveloxolone
• Ondansetron
• Osilodrostat
• Osimertinib
• Oxaliplatin
• Pacritinib
• Paliperidone
• Panobinostat
• Papaverine
• Paroxetine
• Pasireotide
• Pazopanib
• Pentamidine
• Perphenazine
• Phenobarbital
• Phenytoin
• Pimavanserin
• Pipamperone
• Pirtobrutinib
• Pitolisant
• Poliovirus Vaccine, Live
• Ponesimod
• Primidone
• Probucol
• Procainamide
• Prochlorperazine
• Promethazine
• Propafenone
• Protriptyline
• Quetiapine
• Quinidine
• Quinine
• Quizartinib
• Ranolazine
• Relugolix
• Repotrectinib
• Ribociclib
• Rifabutin
• Rifampin
• Risperidone
• Ritlecitinib
• Rotavirus Vaccine, Live
• Rubella Virus Vaccine, Live
• Selpercatinib
• Sertindole
• Sertraline
• Sevoflurane
• Siponimod
• Smallpox Monkeypox Vaccine, Live Non-Replicating
• Smallpox Vaccine
• Sodium Phosphate
• Sodium Phosphate, Dibasic
• Sodium Phosphate, Monobasic
• Solifenacin
• Sorafenib
• Sotalol
• St John's Wort
• Sulpiride
• Sultopride
• Sunitinib
• Tacrolimus
• Tamoxifen
• Telavancin
• Tetrabenazine
• Tizanidine
• Tolterodine
• Toremifene
• Trazodone
• Triclabendazole
• Trimipramine
• Triptorelin
• Trofinetide
• Typhoid Vaccine, Live
• Vandetanib
• Vardenafil
• Varicella Virus Vaccine, Live
• Vemurafenib
• Venlafaxine
• Verapamil
• Vilanterol
• Vinflunine
• Vorinostat
• Yellow Fever Vaccine
• Zoster Vaccine, Live
• Zotepine
• Zuclopenthixol

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

• Grapefruit Juice

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Heart rhythm problems or
• Hyperkalemia (high levels of potassium in the blood) or
• Hypertension (high blood pressure)—Use with caution. May make these conditions worse.

• Kidney disease, severe or
• Liver disease, mild or moderate—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

• Liver disease, severe—Avoid use in patients with this condition.

Proper Use

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Do not stop taking or change your dose without checking first with your doctor.

This medicine comes with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.

Swallow the capsule whole. Do not crush, break, chew, or dissolve it.

It is best to take this medicine on an empty stomach, either 1 hour before or 2 hours after a meal.

Do not eat grapefruit or drink grapefruit juice while you are using this medicine.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (capsules):
  • For active lupus nephritis:
    • Adults—23.7 milligrams (mg) 2 times a day at least 12 hours apart. Do not take it less than 8 hours apart. Your doctor may adjust your dose as needed and tolerated.
    • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If you miss a dose and it is less than 4 hours, take it as soon as possible. If you miss a dose and it is more than 4 hours, skip the missed dose and take your next dose at the regular time.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep this medicine in its original container.

Precautions

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Do not use this medicine if you are also using cyclophosphamide or medicine to treat infections (eg, clarithromycin, itraconazole, ketoconazole).

Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant during treatment. If you think you have become pregnant while using the medicine, tell your doctor right away.

This medicine may increase your risk for certain cancers, including lymphoma or skin cancer. Avoid sun exposure. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds. Talk to your doctor if you have concerns about this risk.

Your body's ability to fight infection may be reduced while you are being treated with voclosporin. It is very important that you call your doctor at the first signs of any infection. Check with your doctor right away if you or your child have fever, chills, cough or hoarseness, flu-like symptoms, lower back or side pain, painful or difficult urination, or unusual tiredness or weakness.

This medicine may cause serious kidney problems. Check with your doctor right away if you have blood in your urine, change in frequency of urination or amount of urine, difficulty in breathing, drowsiness, increased thirst, loss of appetite, nausea or vomiting, swelling of the feet or lower legs, or weakness.

This medicine may cause high blood pressure. Check with your doctor right away if you have blurred vision, dizziness, headache, nervousness, pounding in the ears, or slow or fast heartbeat.

This medicine may cause serious nervous system problems (eg, posterior reversible encephalopathy syndrome). Check with your doctor right away if you have blurred or double vision, difficulty in walking, headache, jaw pain, numbness or tingling in the fingers and toes, pain in the fingers and toes, pain the testicles, or weakness.

Tell your doctor right away if you have confusion, difficult breathing, irregular heartbeat, nausea or vomiting, nervousness, numbness or tingling in the hands, feet, or lips, stomach pain, or weakness or heaviness of the legs. These may be symptoms of hyperkalemia.

This medicine may cause heart rhythm problems (eg, QT prolongation). Check with your doctor right away if you have chest pain or discomfort, fainting, irregular or slow heart rate, or trouble breathing.

While you are being treated with voclosporin, and after you stop treatment with it, do not have any immunizations (vaccinations) without your doctor's approval. Voclosporin may lower your body's resistance and there is a chance you might get the infection the immunization is meant to prevent. In addition, other persons living in your household should not take or should not have taken oral polio vaccine within the last several months since there is a chance they could pass the polio virus on to you. Also, avoid other persons who have taken oral polio vaccine. Do not get close to them and do not stay in the same room with them for very long. If you cannot take these precautions, you should consider wearing a protective face mask that covers the nose and mouth.

This medicine may cause a blood disorder called pure red cell aplasia. Check with your doctor right away if you have fever, sore throat, pale skin, unusual bleeding or bruising, or unusual tiredness or weakness.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

1. Agitation
2. anxiety
3. back pain
4. black, tarry stools
5. bloody or cloudy urine
6. blurred vision
7. body aches or pain
8. burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
9. change in frequency of urination or amount of urine
10. chest pain or discomfort
11. chills
12. coma
13. confusion
14. cough
15. decreased urine output
16. diarrhea
17. difficult, burning, or painful urination
18. dizziness
19. drowsiness
20. dry mouth
21. ear congestion
22. fainting
23. fever
24. frequent urge to urinate
25. general feeling of illness
26. hallucinations
27. headache
28. hostility
29. increased thirst
30. irregular or slow heart rate
31. irritability
32. loss of appetite
33. loss of voice
34. lower back or side pain
35. mood or mental changes
36. muscle twitching
37. nausea or vomiting
38. nervousness
39. numbness or tingling in the hands, feet, or lips
40. painful blisters on trunk of body
41. pale skin
42. pounding in the ears
43. rapid weight gain
44. restlessness
45. seizures
46. slow or fast heartbeat
47. sneezing
48. sore throat
49. stiff neck
50. stomach pain
51. stuffy or runny nose
52. swelling of the face, feet, lower legs, ankles, or hands
53. swollen glands
54. trouble breathing
55. unusual bleeding or bruising
56. unusual tiredness or weakness
57. weakness or heaviness of the legs
58. weight loss
59. yellow skin and eyes

Less common

1. Persistent non-healing sore
2. pink growth
3. reddish patch or irritated area
4. shakiness in the legs, arms, hands, feet
5. shiny bump
6. trembling or shaking of the hands or feet
7. white, yellow or waxy scar-like area

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

1. Acid or sour stomach
2. belching
3. hair loss, thinning of hair
4. heartburn
5. indigestion
6. stomach discomfort or upset

Less common

1. Decreased appetite
2. irritation or soreness of the mouth

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Portions of this document last updated: April 01, 2024

Original article: https://www.mayoclinic.org/ar/drugs-supplements/voclosporin-oral-route/side-effects/drg-20509563