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Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1998.
Ciclosporin (previous spelling, cyclosporin or cyclosporine) is a strong immune suppressant drug and is the main agent used to prevent the rejection of transplanted organs (eg. liver, kidneys, heart). It is also registered in New Zealand to treat the following skin conditions:
Ciclosporin has also be found effective for some cases of other inflammatory skin disorders:
In skin diseases, ciclosporin acts by damping down inflammation in the skin, by its effect on certain immune cells (lymphocytes).
Ciclosporin is normally taken by patients with severe skin disease for a minimum of several months and up to several years.
The dose is usually 2 to 5 mg/kg body weight per day. The capsules should be swallowed whole with a glass of water at the same times each day after breakfast and dinner. It should not be taken with grapefruit juice as this may unpredictably increase the amount of ciclosporin absorbed into the blood stream.
As a powerful medication, ciclosporin may have some serious side effects. It is essential to follow your doctor's advice regarding monitoring of your health. This is especially important when you have first been prescribed the medication, but some side effects become more likely after several months' treatment.
Certain medications should be avoided by patients on ciclosporin. If it is essential to receive treatment with one of these medications, you should ensure your health is monitored carefully by your doctor.
Please refer to the manufacturer's data sheet (see Medsafe) for up-to-date information on drug interactions. Ciclosporin is a P-glycoprotein inhibitor (a CYP3A4 inhibitor).
Ciclosporin may increase the risk of bleeding from anticoagulants such as warfarin or dabigatran.
Tests to exclude latent tuberculosis and hepatitis B/C are wise before starting ciclosporin, and to determine measles and varicella immunity. It is also important to consider need to update immunisation in immunosuppressed dermatology patients.
Side effects from ciclosporin may include:
If you are prescribed ciclosporin for your skin condition, discuss the side effects with your dermatologist. Make sure you understand what to expect, and how to deal with any problems.
Once the skin condition has stabilised on ciclosporin, your dermatologist will advise you to slowly reduce the daily dose of the medication to the minimum which controls the skin condition. Often it is necessary to stop it altogether for a few months to allow side effects to resolve. When ciclosporin is discontinued, the skin condition usually slowly reappears. It can usually be retreated with further ciclosporin or another medication.
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