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Ciclosporin – a tablet used for suppressing immune system
Ciclosporin is a tablet used to suppress the immune system – e.g. to prevent organ transplant rejection, and to treat autoimmune conditions
What is ciclosporin?
- Ciclosporin is an immunosuppressant.
- It belongs to a group of medicines known as calcineurin inhibitors (CNIs), which work by dampening the body’s natural defence system (the immune system).
Uses
Ciclosporin is used to treat people with:
- Organ transplants: To prevent the body from rejecting a kidney, liver, heart, lung or bone marrow.
- Autoimmune conditions: Such as severe psoriasis, atopic dermatitis or rheumatoid arthritis.
- Glomerulonephritis/Nephrotic syndrome: Autoimmune kidney disorders.
- Severe eye inflammation: Such as uveitis.
Dosage
- Dose: very variable depending on use – e.g. after kidney transplant, the maintenance dose is 2–6 mg/kg daily
- Frequency: Usually taken twice daily (12 hours apart).
- Form: Available as capsules, an oral solution, or eye drops.
- Brand specific: Different brands of ciclosporin (e.g. Neoral, Capimune, Capsorin, Sandimmun, Deximune) work differently. You must always stay on the same brand unless your specialist tells you otherwise.
Note. Consistency: It is vital to take it at the same time every day.
Side-effects
Common side-effects
- Kidney: Ciclosporin (and all CNIs) are toxic to the kidneys and can worsen renal (or kidney transplant) function. This is why the minimum dose should be used, and levels monitored (see below).
- Diabetes (new-onset after transplantation; called NODAT): Ciclosporin can reduce insulin production, leading to high blood sugar, and diabetes – in up to 10% of patients. This is usually not reversible.
- Tremors: Shaking, particularly in the hands.
- High blood pressure (Hypertension).
- Gingival hyperplasia: Swollen or overgrown gums.
- Increased hair growth: Male-pattern (hirsutism) – whereas tacrolimus causes hair loss.
Less common (but more serious) side-effects
- Severe Infection: Increased vulnerability to ‘opportunistic’ infections because the immune system is lowered.
- Electrolyte Imbalance: High potassium levels (hyperkalaemia) or low magnesium.
- Cancer: Increased risk of skin cancers and post-transplant lymphoproliferative disorder (PTLD; a form of lymphatic cancer).
- Neurological/Psychiatric: Seizures, loss of consciousness, confusion, changes in mental state, numbness, or tingling.
- Blood/Vascular: Thrombotic microangiopathy (TMA; damage to small vessels), haemolytic anaemia, and abnormal bleeding or bruising.
- Liver: Jaundice (yellowing of skin/eyes), nausea, vomiting, and upper abdominal pain.
- Heart: Ciclosporin rarely causes cardiomyopathy.
Note: Avoid grapefruit and grapefruit juice while taking this medicine, as it can significantly increase the levels of ciclosporin in your blood to a dangerous level.
How it works
- It works by blocking the action of certain cells in your immune system (specifically T-cells) that would normally attack ‘foreign’ tissue or cause inflammation.
- By quieting this response, it prevents the body from rejecting a new organ or attacking its own healthy tissues.
Monitoring
Ciclosporin has a ‘narrow therapeutic index’, meaning the gap between a helpful dose and a toxic dose is small.
Your doctor should monitor:
- Blood (‘trough’) levels: Regular blood tests to measure the concentration of ciclosporin in your blood. This is usually done in the morning before your morning dose. You should miss the morning dose, then take it after the blood test.
- Kidney function: Regular checks of creatinine and GFR.
- Blood glucose: Monitoring for the development of diabetes.
- Liver function: to check for signs of inflammation (hepatitis).
- Blood pressure and Cholesterol: As these can rise during treatment.
