Ciclosporin

Ciclosporin (sic-low-spor-in) is a type of drug known as a disease-modifying anti-rheumatic drug, or DMARD.

In some conditions, the immune system becomes overactive and instead of fighting infection as it’s supposed to, it attacks the body’s own healthy tissues. Ciclosporin can reduce activity in the immune system and help prevent damage to joints.

Ciclosporin can reduce pain, swelling and stiffness in rheumatoid arthritis. It’s also used to treat a number of other autoimmune and inflammatory conditions, including psoriatic arthritis and lupus.

Ciclosporin is a long-term treatment and it may be up to four months before you notice the benefits. It’s important to keep taking it, unless you have severe side effects:

• even if it doesn’t seem to be working at first
• even when your symptoms start to improve, to help keep your condition under control.

Ciclosporin may not be suitable if:

• you have kidney problems
• you have high blood pressure that isn’t controlled by medication
• you have gout or high levels of urate in your blood
• you’ve had cancer.

Your doctor will check your blood pressure and arrange for you to have a blood and urine test before you start treatment.

If ciclosporin isn’t suitable, your doctor will discuss other treatment options with you.

Ciclosporin is usually prescribed under its brand names: Neoral, Deximune and Capimune.

Ciclosporin is taken as capsules to swallow. The capsules will need to be swallowed with water, and you should not chew or open them.

Ciclosporin is also available as a liquid to drink. For this method of taking ciclosporin, you’ll need to measure out the correct dose using the syringe that comes with your medicine. Mix it with water and stir it well. After you’ve taken it, add some more water, swish the water around and drink that, to make sure you’ve taken all the medicine.

Don’t drink grapefruit juice or pomelo juice to take your ciclosporin with. These can increase the amount of ciclosporin in your body and so increase the risk of side effects. It’s best to completely avoid drinking these fruit juices or eating these fruits when taking ciclosporin.

It might be a good idea to take the medicine at the same time each day, so that you get into a routine of taking it.

Your doctor will advise you about the correct dose. Usually you’ll start on a low dose, and your doctor may increase it if necessary. The dose you’re given will depend on your body weight and how well your kidneys are working.

Possible side-effects of ciclosporin include a rise in blood pressure and effects on your kidneys. Ciclosporin can sometimes cause increased levels of lipids (e.g. cholesterol) in the blood.

You'll have regular blood tests and your blood pressure will also need to be checked frequently while you're on ciclosporin. You may be asked to keep a record of your blood test results in a booklet, and you should take it with you when you visit your GP or the hospital. You must not take ciclosporin unless you're having regular checks.

There are different brands of ciclosporin available and, although the drug itself is the same in all the brands, it may be absorbed differently. Your doctor will try to keep you on the same brand if possible. If it's necessary to change to another brand your doctor may advise more frequent checks to make sure the levels of drug in your blood remain the same.

To improve side-effects you may be advised to reduce the dose of ciclosporin.

You should tell your doctor or rheumatology nurse specialist if you develop any of the following after starting ciclosporin:

• nausea (feeling sick)
• diarrhoea
• headache
• gum overgrowth
• tiredness
• excess hair growth
• any other new symptoms or anything else that concerns you.

You should stop ciclosporin and see your doctor immediately if any of these symptoms are severe.

You should also see your doctor if you develop chickenpox or shingles or come into contact with someone who has chickenpox or shingles. These infections can be severe in people on treatments that affect the immune system such as ciclosporin. You may need antiviral treatment, and your ciclosporin is usually stopped until you're better.

Grapefruit and grapefruit juice can increase the effects of ciclosporin, which can also increase the risk of side-effects.

Ciclosporin may be prescribed along with other drugs to treat your condition. However, some drugs may interact with ciclosporin, so you should discuss any new medications with your doctor before starting them, and you should always tell anybody treating you that you're taking ciclosporin.

• You should only take non-steroidal anti-inflammatory drugs (NSAIDs) on the advice of your GP or rheumatologist.
• You can carry on taking painkillers as well as ciclosporin, unless your doctor advises otherwise.
• Don't take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse specialist or pharmacist.

Vaccinations

If you're on ciclosporin it's recommended that you avoid live vaccines such as yellow fever. In certain situations, however, a live vaccine may be necessary (for example rubella immunisation in women of childbearing age), in which case your doctor will discuss the possible risks and benefits of the immunisation with you.

The live shingles vaccination (Zostavax) isn't usually recommended for people who are already on ciclosporin. However, there is a non-live shingles vaccine (Shingrix) so you may be able to have this instead. Your healthcare team will be able to advise on this.

Pneumococcal vaccine (which gives protection against the commonest cause of pneumonia) and yearly flu vaccines don't interact with ciclosporin and are recommended.

There's no particular reason to avoid alcohol while on ciclosporin, so it's fine to drink aclohol in moderation.

Current guidelines state that ciclosporin can be taken during pregnancy. If you’re planning a family or if you become pregnant while taking ciclosporin you should discuss this with your doctor.

The drug may pass into breast milk but is barely detectable in babies, so is unlikely to be harmful.

Men can take ciclosporin when trying for a baby.