BMA Concise Guide to Medicine & Drugs

Ciclosporin

Brand names Deximune, Neoral, Sandimmun

Used in the following combined preparations None

QUICK REFERENCE

Drug group Immunosuppressant drug

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Ciclosporin is an immunosuppressant, a drug that suppresses the body’s natural defences against infection and foreign cells. This action is of particular use following organ transplants, when the recipient’s immune system may reject the transplanted organ unless the immune system is controlled.

Ciclosporin is widely used after many types of transplant, such as heart, bone marrow, kidney, liver, and pancreas; its use has considerably reduced the risk of rejection. It is sometimes used to treat rheumatoid arthritis, some severe types of dermatitis, severe psoriasis, and a number of other autoimmune conditions.

Because ciclosporin reduces the immune system’s effectiveness, people being treated with it are more susceptible than usual to infections. Ciclosporin can also cause kidney damage.

Different brands of ciclosporin may reach different levels in your blood. It is important to know which brand you are taking. Do not try to make dose changes on your own.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Capsules, liquid, injection.

Frequency and timing of doses 1–2 x daily. The liquid can be mixed with water, apple juice, or orange juice just before taking. Do not mix with grapefruit juice.

Dosage range Dosage is calculated on an individual basis according to age and weight.

Onset of effect Within 12 hours.

Duration of action Up to 3 days.

Diet advice Avoid high-potassium foods, such as bananas and tomatoes, and potassium supplements. Avoid grapefruit.

Storage Capsules should be left in the blister pack until required. Keep in original container at room temperature out of the reach of children. Do not refrigerate.

Missed dose Take as soon as you remember. If your dose is more than 36 hours late, consult your doctor.

Stopping the drug Do not stop taking the drug without consulting your doctor; stopping the drug may lead to transplant rejection.

Exceeding the dose An occasional unintentional extra dose is unlikely to cause problems. Large overdoses may cause vomiting and diarrhoea and may affect kidney function. Notify your doctor.

POSSIBLE ADVERSE EFFECTS

The most common adverse effects are gum swelling, excessive hair growth, nausea, vomiting, and tremor, especially at the start of treatment. Less common effects include diarrhoea, facial swelling, flushing, pins and needles sensations, rash, and itching. Consult your doctor if any of these effects occur.

INTERACTIONS

General note Ciclosporin may interact with a large number of drugs. Check with your doctor or pharmacist before taking any new prescription or over-the-counter medications. Grapefruit juice can increase blood levels of ciclosporin. Avoid all grapefruit flesh and juice while taking ciclosporin. St John’s wort can reduce ciclosporin levels and even precipitate rejection of a transplanted organ. Avoid St John’s wort completely while taking ciclosporin.

SPECIAL PRECAUTIONS

Ciclosporin is prescribed only under close medical supervision, taking account of your condition and medical history.

Pregnancy Use in pregnancy depends on condition under treatment. Discuss with your doctor.

Breast-feeding Not recommended. The drug passes into the breast milk and safety has not been established. Discuss with your doctor.

Infants and children Used only by specialist children’s doctors.

Over 60 Reduced dose may be necessary.

Driving and hazardous work No known problems.

Alcohol No known problems.

Vaccination Avoid vaccination with live attenuated vaccines.

Sunlight and sunbeds Avoid prolonged, unprotected exposure; apply sunscreen or sunblock.

PROLONGED USE

Long-term use, especially in high doses, can affect kidney and/or liver function. It may reduce numbers of white blood cells, thus increasing susceptibility to infection.

Monitoring Regular blood tests should be carried out as well as tests for liver and kidney function. Ciclosporin blood levels should also be checked regularly.