Cyclorin

Indications

Cyclosporine (also spelled ciclosporin) calms the immune system. Taken by mouth or given by injection, it is used to prevent rejection after organ or bone marrow transplants and to treat severe psoriasis, severe atopic eczema, severe rheumatoid arthritis and some kidney diseases. As eye drops or eye emulsion, it is used for chronic dry eye caused by inflammation and for some allergic eye conditions.

How It Works

Cyclosporine blocks a signal inside T cells, the white blood cells that drive immune attacks. With fewer active T cells, the body is less likely to attack a transplanted organ, and inflammation in the skin, joints or eye surface settles. In the eye it also helps the tear glands make more natural tears.

Dosage and Administration

Capsules, oral solution and injections are specialist medicines: the dose is worked out from body weight and blood levels and must be taken exactly as prescribed, at the same times each day. Do not switch between brands of capsules without your doctor's advice, because they are not always absorbed the same way. Injections are given by a doctor or nurse. Eye drops are usually used one drop in each affected eye twice a day, about 12 hours apart, or as prescribed; remove contact lenses first and wait 15 minutes before putting them back.

Interactions

Oral cyclosporine has many important interactions. Ketoconazole, Itraconazole, Clarithromycin, Erythromycin, Diltiazem, Verapamil and grapefruit juice can raise its level. Rifampicin, Carbamazepine, Phenytoin and St John's Wort can lower it. Use with Tacrolimus, Aminoglycosides, NSAIDs such as Diclofenac, or potassium-sparing diuretics can harm the kidneys or raise potassium. It raises levels of Statins, Digoxin and some others. Avoid live vaccines. Always tell every doctor and pharmacist that you take it.

Contraindications

• Allergy to cyclosporine or any ingredient
• For psoriasis, eczema or arthritis: poor kidney function, uncontrolled high blood pressure, uncontrolled infection or a cancer
• Eye drops: active eye infection

Side Effects

Oral or injected use: raised blood pressure, reduced kidney function, tremor, headache, gum overgrowth, increased hair growth, stomach upset, high potassium and cholesterol, and a higher chance of infections. Long term use may slightly raise the risk of skin cancer and lymphoma. Eye drops: burning or stinging, redness and blurred vision for a short time after use.

Get urgent medical help for fever or signs of serious infection, a very bad headache with vision changes or fits, much less urine, yellow skin or eyes, or a severe allergic reaction.

Pregnancy and Lactation

Oral cyclosporine is used in pregnancy only when the doctor judges the benefit is greater than the risk, such as after a transplant. It passes into breast milk, so breastfeeding is usually not advised while taking it by mouth. Eye drops reach the blood in only tiny amounts, but ask your doctor before use.

Precautions and Warnings

Regular checks of blood pressure, kidney function, blood levels, potassium and lipids are needed. Protect your skin from strong sun. Keep teeth and gums clean. Report any infection early.

Overdose

An oral overdose may cause kidney damage, vomiting, drowsiness and headache. Seek medical help at once. Too many eye drops rarely cause harm.

Therapeutic Class

Immunosuppressant (calcineurin inhibitor)

Storage

Store below 30°C, away from light and moisture, out of the reach of children. Do not refrigerate capsules or oral solution unless the label says so. Eye drop single-use vials should be thrown away after one use.