Ciclosporin

Question 1

What are its indications?

Answer 1

Severe UC
Severe rheumatoid arthritis
atopic dermatitis
psoriasis
organ transplant
nephrotic syndrome

Question 2

CICLOSPORIN;
why must it be prescribed by brand?

Answer 2

switching without close monitoring can lead to important changes in blood concentration.

Question 3

CICLOSPORIN;
What are monitoring requirements?

Answer 3

Blood ciclosporin concentration should be monitored throughout treatment

Renal function should be monitored – an increase in serum creatinine and urea may call for a dose reduction (in transplant patients) or discontinuation of treatment (in non-transplant patients)

Blood pressure should be monitored 🡪 discontinue if hypertension develops that cannot be controlled with antihypertensives.

Blood pressure and renal function should be measured atleast twice before starting therapy for psoriasis or eczema.

Blood lipids should be measured before and after the first month of treatment
Monitor liver function.

In rheumatoid arthritis, measure serum creatinine atleast twice before treatment.

During treatment, monitor serum creatinine every 2 weeks for the first 3 months and then every month for a further 3 months.

Question 4

CICLOSPORIN;
What is it indicated for?

Answer 4

UC
severe Rheumatoid arthritis
severe atopic dermatitis
psoriasis
bone marrow transplantation
organ transplant

Question 5

What is dosage based on?

Answer 5

indication
weight

Question 6

What are eye formulations indicated for?

Answer 6

ikervis- keratitis in dry eye disease that has not responded to treatment with tear substitutes.

Question 7

What is dosage for ikervis?

Answer 7

Apply 1 drop once daily, to be applied to the affected eye(s) at bedtime, review treatment at least every 6 months.

Question 8

What is important MHRA warning regarding ciclosporin ?

Answer 8

stabilised on a particular brand of oral ciclosporin because switching between formulations without close monitoring may lead to clinically important changes in blood-ciclosporin concentration.

Question 9

What are important side effects?

Answer 9

eye;
discomfort, inflammation, blurred vision

oral;
Appetite decreased; diarrhoea; electrolyte imbalance; hair changes; headaches; hepatic disorders; hyperglycaemia; hyperlipidaemia; hypertension; hyperuricaemia; peptic ulcer; renal impairment seizure; skin reactions; tremor; vomiting

Question 10

What are monitoring requirements?

Answer 10

-blood ciclosporin concentrations
-blood pressure and renal function should be measured twice before starting therapy for psoriasis or eczema.
-blood lipids
-Monitor serum potassium, especially in renal
dysfunction (risk of hyperkalaemia).
-monitor liver function. (especially if using NSAIDs)
-Monitor serum magnesium.
-rheumatoid arthritis- serum creatinine at least twice before treatment, during treatment 2 weekly for first 3 months, then every month for 3 month,

Question 11

How should orally be administered?

Answer 11

Manufacturer advises mix solution with orange or apple juice, or other soft drink (to improve taste) immediately before taking (and rinse with more to ensure total dose). Do not mix with grapefruit juice.

Total daily dose should be taken in 2 divided doses.

Question 12

How should ikervis be administered?

Answer 12

keep eyes closed for 2 minutes after using eye drops to increase local drug action and reduce systemic absorption.

Question 13

what are important interactions?

Answer 13

non-steroidal anti-inflammatory drugs (eg Ibuprofen), St John’s Wart and erythromycin.

Affected by CYP inducers