Other Brands/Names

Ikervis, Cipol-N, Sandimmun Neoral.

How It Works

Ciclosporin is an immunosuppressant. It weakens the immune response to help the body accept a transplanted organ and to prevent the body from rejecting the organ.

Indications

• Ciclosporin is used with other medicines to prevent rejection after organ transplantation such as kidney, liver, and heart transplants.

• (Modified) ciclosporin is used as a singular treatment or combined with other medicines like methotrexate to treat the symptoms of rheumatoid arthritis (long-term joint inflammation caused by the immune system mistakenly attacking the joints) in patients whose symptoms do not improve with methotrexate alone.

• (Modified) ciclosporin is also used to manage psoriasis (a skin disease in which red, scaly patches appear on several areas of the body) in selected patients who have not improved with other treatments.

• Eye drops: treats dry-eye symptoms in cases of keratitis (inflammation of the cornea).

Contraindication

• History of allergy to ciclosporin.

• In non-organ transplant patients: impaired kidney function, uncontrolled hypertension, malignant tumors, uncontrolled infections.

Side Effects

• Tremor, headache, dizziness, abnormal body-hair growth, nausea/vomiting, diarrhea, abdominal pain, or facial flushing may occur; if any of these effects persist or worsen, notify your doctor promptly.

• Abnormal gum overgrowth and swelling can occur; brush and floss daily to reduce these problems, and see your dentist regularly.

• This medicine may increase blood pressure; monitor your blood pressure regularly and tell your doctor if readings are high.

• Seek medical advice right away if you develop serious effects, including: signs of kidney disease (such as reduced urine output), signs of liver disease (such as persistent nausea/vomiting, dark urine, yellowing of the eyes/skin, stomach pain), easy bruising/bleeding, unusual tiredness, muscle weakness/spasms, slow/irregular heartbeat, skin numbness/tingling, or severe leg pain.

• Get emergency help if very serious effects occur, including: mental or mood changes (such as confusion, difficulty concentrating), vision problems, speech problems, clumsiness, loss of balance, weakness on one side of the body, chest pain, or seizures.

Types

Ciclosporin is available as capsules, syrups, and eye drops.

Dosage

• Adults (organ transplant patient): initial dose 10–15 mg/kg per day in 2 divided doses, starting 4–12 hours before transplantation and continued for 1–2 weeks after surgery, then tapered gradually. Maintenance dose: 2–6 mg/kg per day in 2 divided doses. A lower initial dose may be used in combination with other immunosuppressants (for example, corticosteroids).

• Eye drops: instill one drop nightly at bedtime in the affected eye.

Safety

• This medicine may cause dizziness; do not drive, operate machinery, or perform tasks requiring alertness until you can do so safely. Avoid alcoholic beverages.

• Ciclosporin may increase risks of infections or worsen existing infections. Avoid contact with people who have infections that can spread to others (such as chickenpox, measles, or influenza).

• Inform your healthcare professional that you are using ciclosporin before any immunizations/vaccinations. Avoid close contact with people who have recently received live vaccines.

• This medicine may increase the risk of skin cancer; avoid direct sun exposure. Use sunscreen and wear protective clothing when outdoors.

• During pregnancy, use only if clearly needed; this medicine may harm the fetus or lead to premature birth or low birth weight. Discuss risks and benefits with your doctor.

• This medicine is excreted in breast milk; because of potential adverse effects on the infant, breastfeeding while taking ciclosporin is not recommended. Consult your doctor before breastfeeding.

Drug Interactions

Potentially fatal: increased risk of skin cancer when used with other immunosuppressive agents (for example, methotrexate) in patients with psoriasis.

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