Using Cyclosporine In Dogs & Cats

Updated November 28, 2020

The use of Atopica® for dermatitis is a tale of two very different species: dogs and cats.  What was once a very useful drug in dogs has turned into an essential part of treating skin diseases in cats.

Now I use it far more in cats than dogs. Keep reading on to see why.

What Is Atopica?

Atopica is a brand name of cyclosporin, which you’ll also see spelled cyclosporine, ciclosporine or ciclosporin. It’s a reasonably targeted immune suppressant that was first used in people having organ transplants. However, due to unpleasant side effects, it was never widely used elsewhere.

In dogs however, its release marked a watershed moment for veterinary medicine. Atopica was the first drug specifically licensed for atopic dermatitis, which until then had only been treated with prednisolone. For the first time, dogs could expect to get relief from constant itching without suffering excessive side effects.

Its greatest disadvantage was its cost. At the time I predicted a great future when it came off patent and became a cheaper generic. That never happened, partly due to the inherent high cost of manufacture, but mostly because no one saw what would happen next.

Atopica vs Apoquel In Dogs

Vets struggled on, treating atopy with cyclosporin for ten years. Then Apoquel came like a bolt out of the blue and almost overnight Atopica was forgotten. You can read about Apoquel here; most vets would agree that it:

  • works better
  • starts working faster
  • costs about the same
  • has fewer side effects (see these later)

Since then, Cytopoint also appeared, giving just one more reason not to use Atopica. 

Nowadays, cyclosporin is mainly used for dogs with unusual immune-mediated or autoimmune diseases like:

  • Perianal fistula
  • Lupus diseases
  • Cutaneous histiocytosis

And perhaps still for atopic dogs when Apoquel and Cytopoint don’t work.

Atopica In Cats

Cats are a very different story. A poor cat suffering from allergic dermatitis still mostly only gets treated with prednisolone. That’s because Apoquel is unlicensed in cats, and Cytopoint being a dog antibody could cause a dangerous reaction. 

Long term prednisolone use in cats puts them at risk of diabetes. So I was grateful when Elanco developed Atopica for cats, even though the economics must be marginal. It’s great to have a choice.

Uses for cyclosporin in cats include:

But cyclosporin isn’t a wonder drug. It has important drawbacks especially for cats.

(Note: this article gets quite technical from here so feel free to skip the rest unless you’re keen.)

Atopica Side Effects

The common side effects of cyclosporin in dogs and cats are listed below. 

Side effectCatsDogs
Vomiting12% 25%
Weight loss5-16%n/a
Not eating2-10%1-4%

Most of the time, vomiting will improve over a few weeks if you keep using the drug. However, symptoms can be severe enough to need to stop the drug. Giving cyclosporin with food can decrease gastrointestinal adverse effects but may reduce absorption.

Additionally, the following side effects also occur at a lower rate:

  • Gingival hyperplasia (overgrowth of the gums)
  • Hypertrichosis (thicker hair)
  • Warts & verrucas (dogs only)
  • Muscle cramps and weakness 
  • Acute bullous keratopathy (a cat eye disease)

Cancer is often discussed but it’s very hard to tell if cyclosporin changes what is already a very common problem. Cats however have one more very specific and important risk: opportunistic infection.

Cats, Cyclosporin & Toxoplasmosis

When cats are taking Atopica, their immune system is unable to defend them against certain common diseases.

Herpesvirus cat flu is one. A previously vaccinated cat is safe, but if an unprotected cat catches herpes, it could be fatal. Therefore we won’t use Atopica without prior vaccination. Future vaccination is safe but we avoid live vaccines.

FeLV and FIV are two others. Cats carrying these viruses should not be given cyclosporin so we always test them first. Then it’s a good idea to vaccinate or keep cats indoors to prevent future infection.

The greatest threat is Toxoplasma. If a cat acquires this parasite for the first time while on Atopica, it’s usually fatal. But as dramatic as this is, it can be prevented. Here’s how:

  • Perform a Toxoplasma titre before commencement. If there’s an existing antibody level, your cat has already been exposed to Toxoplasma and therefore should be safe (like vaccination). 
  • Keep cats with negative titres and all their housemates inside. Feed them on commercially prepared tinned or dry foods only, and control mice in the house.

Read more about toxoplasmosis in cats here.

Atopica Doses For Dogs & Cats

Cats are given an oral liquid which allows for accurate dosing. Cyclosporin is started at 7 mg/kg once a day with or without food until the skin improves, usually in 4-8 weeks. Then the dose is tapered to every second day or, when possible, to twice weekly. 

Dogs receive Atopica capsules in either 10, 25, 50 or 100 mg. Cyclosporin is given on an empty stomach at 5 mg/kg once daily until improvement, typically for 4 to 6 weeks. After this, dose reduction is possible in around a half of dogs. Treatment is then trialled at every second day and if this also works, a further reduction to twice weekly is tried.

In both species, cyclosporin is slow to reach its full effect. After 1 month, around 50% can expect to get at least 50% improvement in their signs. There is usually further improvement until it plateaus at 2-4 months. 85% of dogs can expect to get at least 50% improvement by this time. Cats are probably similar.

Thanks for making it to the end. You might also be interested in reading about the two related conditions, food allergy and flea allergy. The picture at the start shows how similar the patterns in cats are for these important skin problems. It’s just as hard in dogs.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

37 Replies to “Using Cyclosporine In Dogs & Cats”

  1. Our 5 yr old GSD has been on Atopica for 2 months to treat recently diagnosed Seborrhoeic Adenitis. We are ( only just) starting to see first signs of skin improvement and hair regrowth but over the last week or two he has developed lethargy, body tremors at rest and a rear leg lameness. Could this be a side effect of, or related to the Atopica?

    1. Hi Lesley. It doesn’t sound like a side-effect I am aware of so get back in touch with your local vets for a check up as soon as possible. Good luck.

    2. Our cat has been on Atopica for 2 weeks and is experiencing rear leg lameness as well

  2. Thanks for the informative article. We are considering putting our cat on cyclosporine for immune-mediated cholangiohepatitis, as prednisolone made her ALTs significantly worse and chlorambucil did not make them better. Have you seen cyclosporine’s use for that condition? If so, thoughts on it’s effectiveness?

  3. We have our lovely but always itchy 6 year old male cat, vet has suggested cyclosporine. However he has a history of cat flu (when tiny kitten), severe kidney disease at 18 months (recovered) and then diagnosed age 4 with cardiomyopathy. Currently on Sotalol. I’m concerned that cyclosporine and side effects may be too much for his system to cope with? What’s your thoughts?

    1. Hi Sandra. I’m sure your vet has factored these into the recommendation, and if it’s monitored carefully, I can’t see a concern.

  4. Thank you! My cat is allergic to everything with a shadow and it’s been impossible to eliminate all allergens (one of which might even be human skin). She’s on dexacortone now, but my vet has suggested cytosporin as a long term solution. Sounds like a good idea from what I’m reading here.

  5. I just wanted to say a thanks, for your comprehensive article. My foster cat has been on steroids for her all over allergic dermatitis, but she has been getting other infections (ear and chest) and we want to home her. She has been weaning off the steroids but having a flair up so this has helped me to decide what to wean her on to in an effort to get her stable and ready for a new home!

  6. Hello, thank you in advance for reading and replying. For how many years can a cat take Atopica in an off-label context, please?

    1. Hi Sandra. As long as your vet feels it remains safe, and you give appropriate consent, there is no limit.

  7. My vet said atopica capsule is safe for my cat, is this true? Liquid is so unpleasant

    1. Hi Donald. There are two parts to this question. The first is whether the dose is equivalent, in which case there should be no difference. However, the second is whether it is allowable by your regulatory authorities to use off label products (this would be if the capsules are registered for use in dogs, not cats). The answer to this varies a lot by country.

  8. Hi, my dog is on cyclosporine for skin issues. Not seeing any effect after 2 months. Is it safe to stop cyclosporine cold turkey? Or is a taper period absolutely necessary? If so, why?

    1. Hi Ryan. I’m not aware of any need to taper cyclosporine but as always, defer to the advice of your vets.

  9. My 8-year old 18 lb chihuahua minpin mix suddenly had idiopathic hemolytic anemia 1 1/2 years ago. He almost died, transfusions saved him, and ever since has been on cyclosporine 75 mg daily, clopedigril, and prednisone. I’m slowly phasing our prednisone with vet approval, but I also want to do same with cyclosporine. Questions: can The other, newer versions of cyclosporine do a better job with fewer side effects? Second, there’s little data on this condition beyond one year, and that 50-70% of dogs with it die in year 1. Mine is ok at 1 1/2 years. Have you successfully phased out cyclosporine and clopedigril after one year, as I have prednisone?

    1. Hi Steve. I’m unaware of the new form of cyclosporine, but if it is approved by the FDA or TGA, it should be equivalent. As for phasing out the drugs, IMHA is not considered a permanent condition in most cases, and it is quite reasonable to attempt it under veterinary instructions.

  10. My 18 year old rescue cat is very nervous. Has been on thyroid food for 12mths seems to be doing ok but has developed terrible itch and bleeds around head and neck. So take tablets. Have given xylene caps opened in food would like to add atopica in same way cos he ca’t take liquid is this ok please

    1. Hi Anita. Surely not xylene?! As for your question, I ask whether your cat’s thyroid disease control has been confirmed via blood tests. Be careful as self trauma to the head and neck can occur both in poorly controlled hyperthyroidism AND as a side effect of antithyroid medications. These questions need answering before considering new drugs.

    2. Hi, yes, I give my cat Atopica in a capsule every day wrapped in cream cheese. He suffers from EGC which is a lifelong condition. He’s not even 3 yet. The Atopica controls it very well. The pills go by weight, your vet will give you the right dose. The Prednisolone made the condition go away but it always came back and steroids are more dangerous. Atopica is not without risk but quality of life is so very important. You have to find the lowest dose possible that works. Good luck.

  11. Our dermatology vet has prescribed 75 mg of atopica daily for pimpicus ereathematous in our 14 year old 30 lb terrier mix. She doesn’t believe the generic cyclosporine doesn’t work as well. He has been on Prednisone and another high powered steroid on and off for about 2 years. The crustation on his nose and eyes is well controlled but he has a 3.5″ spot on his back that is persistent and itchy. Presently giving 2 benadryl/ day and anti- itch spray but a 50/50 natural vinegar and water spray seems to work better.
    Question ❓ would apoquel or cyclosporine be better in your opinion?
    Thank you

    1. Hi Lynne. I agree that the brand-name product appears to be more efficacious. I believe the disease you are referring to is Pemphigus erythematosus.

  12. My cat has high ALT levels/liver issues but confirmed not cancer – is there a reason our vet is recommending this?! It definitely feels like this product is used for other ailments. :/

    1. Hi Lauren. It’s not clear from what you say, but I’m guessing your vet has something in mind.

    1. Hi Kathy our GS also has Furunculosis. After 3 surgeries and treatment with prednisolone & cyclosporine cream she has finally been put on 100mg Cyclosporine & 200mg of an anti fungal. She is coming to the end of her 4th month and it has improved a lot but she is not the same dog she was before all this started. The prednisolone broke her…. It was heartbreaking & definitely a case of the side effects outweighing the benefits. We will be starting the maintenance dose next week. How is your dog going?

  13. My Dog has been diagnosed with IBD. She is a 6lb chihuahua. Her vet prescribed Atopica for cats- liquid. 1.7 twice a day. Is it safe and is it effective for a dog to take this cat medicine? I ask because this far she has shown little sign of improvement. She still rejects her HA diet and seems to have little energy. I thought maybe she should be taking medicine designed for cats?

    1. Hi Amye. Your vet is using the cat product as there is no way to use the dog capsules without overdosing in such a small dog.

  14. Is the generic version of Atopica (Cyclosporine (non-modified) Compounded Oral Liquid) just as effective for cats? Thanks

      1. Why would the generic not work the same as atopica, once it is the same medication and much less expensive?

      2. Hi Erich. I’m not saying that it won’t, but you have to be sure that it is made to the same standards. This you can reasonably safely assume if it is registered for use by your country’s regulatory body such as the FDA or TGA. Of course, vets still have the additional hypothetical legal problem of using an unregistered product when a registered product exists for a particular disease. How much this matters will depend on the zeal of the regulatory agency.

  15. Since Atopica for cats is back ordered by the manufacturer, can I give my cat the Atopica capsules that are for dogs?

    1. Hi Mary. The two problems will be the inflexible dose size (25 or 50mg) and the large capsules. Talk it over with your vet in case there is another alternative for your cat’s condition.

    1. Hi Errin. Yes, it is used for anal furunculosis, and I should have included this use above. When doing so, it usually causes the disease to go into remission, at least while on treatment. The main disadvantage is cost due to the dose needed, as the disease mostly affects large breeds.

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