Ciclosporin Flashcards
What is ciclosporin
A calcineurin inhibitor that is a potent immunosuppressant which is virtually non-myelotoxic but marked nephrotoxic
May require loading doses
What are the warning signs of ciclosporin that require referral to the doctors
Neurotoxicity (tremor, headache, encephalopathy- confusion and convulsions)
Nephrotoxicity (elevated serum creatinine concentrations)
Liver toxicity (dark urine, jaundice, nausea, vomiting, abdominal discomfort)
Vomiting, nausea, tachycardia
Benign Intracranial hypertension (headache, visual disturbances, discontinue if occurs)
Hypertension
Blood disorders (fever, sore throat, mouth ulcers, unexplained bleeding or bruising)
Gingivial hyperplasia
What are the monitoring requirements needed for ciclosporin
FBC Liver function Serum electrolytes (K+ and Mg2+) Blood lipids Renal function (creatinine, urea) Blood pressure Dermatological and physical examination
What are the other points you should know about ciclosporin
Avoid excessive exposure to UV light- including sunlight
Use wide spectrum sunscreen to reduce secondary skin malignancies
Avoid a high potassium diet and grapefruit juice
The oral solution can be taken with orange or apple juice to improve the taste
Must not receive live immunisation with live vaccines
Stay on the same particular brand
What are the main interactions involved with ciclosporin
Increased plasma concentration with clarithromycin, erythromycin, fluconazole, grapefruit juice, ketoconazole, miconazole, verapamil and tacrolimus
Increased risk of nephrotoxicity and myotoxicity with colchicine
Decreased plasma concentration with carbamazepine, orlistat, phenobarbital, phenytoin, rifampicin, St Johns Wort
Increased risk of hyperkalaemia when ciclosporin given with ACE inhibitors, ARBS, or aldosterone antagonists
Increased nephrotoxicity when given with NSAIDS, plus increase plasma concentration with diclofenac
Increased myopathy risk when given with statins (AVOID)
