{"id":1583,"date":"2018-09-12T13:30:01","date_gmt":"2018-09-12T13:30:01","guid":{"rendered":"http:\/\/edren.org\/ren\/?page_id=1583"},"modified":"2019-06-27T11:02:47","modified_gmt":"2019-06-27T11:02:47","slug":"ciclosporin","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/handbook\/transplant-handbook\/immunosuppressive-drugs\/ciclosporin\/","title":{"rendered":"Ciclosporin"},"content":{"rendered":"

Current Indication:<\/span><\/strong><\/p>\n

No longer a first line agent but some transplant patients will still have Neoral (previous formulation Sandimmun but nearly all patients are on Neoral) as the lead agent in their immunosuppression regime.<\/span><\/p>\n

Dose:<\/span><\/strong><\/p>\n

Starting dose is 8 mg\/kg\/day in 2 divided doses.<\/span><\/p>\n

Preparation:<\/span><\/strong><\/p>\n

Ciclosporin is available 10 mg (yellow \/ white), 25 mg (blue \/ grey), 50 mg (yellow \/ white) and 100 mg (blue \/ grey) capsules and as a 100 mg\/ml oral solution.<\/span><\/p>\n

Different generic preparations of ciclosporin may vary in bioavailability and should not be considered interchangeable.<\/span><\/p>\n

Within NHS Lothian the formulation in use for solid organ transplantation is Neoral\u00ae<\/sup>.\u00a0 As ciclosporin is a drug with a narrow therapeutic index drug it is vital that patients are not switched between formulations. Therefore care must be taken to prescribe and dispense ciclosporin by BRAND name to avoid potential toxicity or potential graft rejection.<\/span><\/p>\n

Administration:<\/span><\/strong><\/p>\n

Oral route in most instances.<\/span><\/p>\n

It is administered usually at 10 am and 10 pm.<\/span><\/p>\n

Oral solution should be diluted immediately before taking. It may be diluted in orange juice or squash, apple juice or water (not grapefruit juice – see interactions) and needs to be stirred well. Measuring device should not come into contact within the dilutent.<\/span><\/p>\n

One third of the oral dose can be given as a slow intravenous infusion in normal saline or dextrose 5% over 2-6 hours if absolutely necessary.<\/span><\/p>\n

N.B the injection is only available in the Sandimmun brand and care should be taken if switching patients who are on the Neoral brand.<\/span><\/p>\n

Contra-indications\/Cautions:<\/span><\/strong><\/p>\n

Live vaccines are not to be given to immunocompromised patients.<\/span><\/p>\n

Neoral should be used with caution during pregnancy.<\/span><\/p>\n

Ciclosporin passes into breast milk so mothers should not breast feed their infants.<\/span><\/p>\n

Side effects:<\/span><\/strong><\/p>\n

The most frequent side effects seen with Ciclosporin include:<\/span><\/p>\n\n\n\n\n\n\n
abnormal kidney function<\/span><\/td>\nhepatic dysfunction<\/span><\/td>\n<\/tr>\n
hypertrichosis<\/span><\/td>\ngingival hypertrophy<\/span><\/td>\n<\/tr>\n
tremor<\/span><\/td>\ngastrointestinal disturbances<\/span><\/td>\n<\/tr>\n
hypertension<\/span><\/td>\n\u00a0burning sensation of hands and feet<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Less common side effects are:<\/span><\/em><\/span><\/p>\n\n\n\n\n\n\n\n\n
headaches<\/span><\/td>\noedema<\/span><\/td>\n<\/tr>\n
mild anaemia<\/span><\/td>\npancreatitis<\/span><\/td>\n<\/tr>\n
hyperkalaemia<\/span><\/td>\nneuropathy<\/span><\/td>\n<\/tr>\n
Hyperuricaemia<\/span><\/td>\nreversible dysmenhorrhoea<\/span><\/td>\n<\/tr>\n
hypomagnesaemia<\/span><\/td>\nmuscle weakness, cramps, myopathy<\/span><\/td>\n<\/tr>\n
hypercholesterolaemia<\/span><\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Interactions:<\/span><\/strong><\/p>\n

Potential interactions due to effects on hepatic microsomal enzymes:<\/em><\/span><\/p>\n

Inhibitors of cytochrome P450 which may decrease metabolism of ciclosporin and thus increase ciclosporin blood levels include:<\/span><\/p>\n