Ciclosporin

Key facts

• Ciclosporin (cyclosporine) is a calcineurin-inhibitor immunosuppressant. It is used to prevent rejection after organ or bone marrow transplant and to control severe autoimmune conditions such as psoriasis and rheumatoid arthritis.
• It has a narrow therapeutic index: too little and rejection or disease flares can occur, too much and the kidneys are damaged. Your prescriber sets your dose from regular blood-level tests, kidney function tests and blood-pressure readings.
• Because it suppresses your immune system, you carry a higher risk of infections and, with long-term use, certain cancers including skin cancer and lymphoma.
• Seek urgent care for a marked drop in urine output, swelling, severe headache with vision changes, fever or any sign of infection you cannot explain.

What ciclosporin treats

Ciclosporin prevents the immune system from rejecting a transplanted kidney, liver, heart or bone marrow. It also treats autoimmune and inflammatory conditions where the immune system attacks the body's own tissue, including severe plaque psoriasis, rheumatoid arthritis that has not responded to other treatments, and nephrotic syndrome. Ophthalmic drops containing ciclosporin treat chronic dry eye caused by inflammation.

How ciclosporin works

Ciclosporin blocks calcineurin, an enzyme inside T-lymphocytes (a type of white blood cell) that normally switches on genes needed to activate the immune response. By stopping calcineurin from working, ciclosporin prevents T-cells from multiplying and attacking transplanted tissue or the body's own cells, dampening the immune and inflammatory response.

Before you take it

• Do not take ciclosporin if you have uncontrolled high blood pressure, an active uncontrolled infection, or abnormal kidney function that has not been assessed, unless your specialist judges the benefit outweighs the risk.
• Tell your prescriber about all other medicines, including St John's wort (it lowers ciclosporin levels and risks rejection), grapefruit juice, NSAIDs, certain antibiotics and antifungals (they can raise ciclosporin levels), and live vaccines, which should be avoided during treatment.
• Ciclosporin can raise blood pressure and cholesterol and cause gum overgrowth and excess hair growth; tell your dentist and prescriber if these occur.
• Avoid other people's illnesses where possible, and tell your prescriber promptly about any fever, cough or infection symptom.

Side effects

Common effects include tremor, headache, high blood pressure, increased hair growth, gum swelling, nausea and tingling in the hands or feet.

Stop and seek urgent medical care for any of these:

• A marked reduction in urine output or swelling of the legs or face.
• Severe headache, confusion, seizures or sudden vision changes.
• Fever, sore throat or other signs of infection.
• Yellowing of the skin or eyes.

Safety essentials

• Kidney damage is the defining risk of ciclosporin treatment. You need regular blood tests to measure ciclosporin levels, kidney function and blood pressure for as long as you take it, and your dose is adjusted from these results.
• Because ciclosporin suppresses your immune system, report infections early and discuss any vaccination with your prescriber before having it.
• Never change your dose or brand of ciclosporin without medical advice; different formulations are not always interchangeable, and levels can shift with the change.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.