Ciclosporin

Question 1

Monitoring

Answer 1

Full blood count, liver function, serum electrolytes (K+, Mg2+), blood lipids, renal function (including
creatinine, urea), blood pressure, dermatological and physical examination

Question 2

Warning Signs

Answer 2

• Neurotoxicity e.g. tremor, headache, encephalopathy (e.g. confusion, convulsions)
• Blood disorders (signs of infection such as fever, sore throat, mouth ulcers, also unexplained
bruising or bleeding) e.g. leucopenia, thrombocytopenia
• Liver toxicity e.g. jaundice, nausea, vomiting, abdominal discomfort, dark urine
• Nephrotoxicity e.g. elevated serum creatinine concentrations
• Other signs of toxicity - vomiting, drowsiness, tachycardia
• Hypertension
• Headache
• Gingivial hyperplasia

Question 3

Actions Required

Answer 3

• Advise patient to report immediately to a doctor if any warning signs occur
• Hypertension is a common side-effect of ciclosporin therapy. Advise patient to have their
blood pressure monitored regularly
• Warn patients that they must not receive immunisation with live vaccines
• Brand-specifc prescribing is recommended (if changing brand monitor closely for changes in
ciclosporin level, serum creatinine and blood pressure)

• Advise patient to avoid excessive exposure to UV light, including sunlight and to use a wide-
spectrum sunscreen (may reduce risk of secondary skin malignancies). Patients with atopic dermatitis and psoriasis should avoid use of UVB or PUVA
• Advise patient to avoid a high potassium diet and grapefruit juice. The oral solution formulations
can be taken with orange or apple juices to improve taste

Question 4

Interactions

Answer 4

• Increased plasma concentration with clarithromycin, diltiazem, erythromycin, fuconazole,
grapefruit juice, itraconazole, ketoconazole, miconazole, metoclopramide, verapamil,
colchicine (with which concomitant use also increases risk of nephrotoxicity and myotoxicity)
and tacrolimus (avoid)
• Decreased plasma concentration with carbamazepine, orlistat, phenobarbital, phenytoin,
rifampicin, St. John’s Wort
• Increased risk of hyperkalaemia when ciclosporin given with ACE inhibitors or angiotensin-II
receptor antagonists, aldosterone antagonists
• Increased risk of nephrotoxicity when ciclosporin given with NSAIDs and increased plasma
concentration of diclofenac
• Ciclosporin increases plasma concentration of digoxin (increased risk of toxicity)
• Increased risk of myopathy when ciclosporin given with atorvastatin, fuvastatin, pravastatin,
rosuvastatin, simvastatin (avoid concomitant use)