week 3-ciclosporin

Question 1

what kind of drug is ciclosporin?

Answer 1

Calcineurin inhibitor

Question 2

wha are the indictaions for ciclosporin?

Answer 2

• Inflammatory bowel disease
• Immunosuppressive therapy in transplant patients (SOT and bone marrow)
• Psoriasis
• Severe atopic dermatitis
• Rheumatoid arthritis

Question 3

what are some common side effects of cicolosporin?

Answer 3

GI, fatigue, convulsions, headache, muscle cramps, myalgia, tremor,
hyperglycaemia, hyperlipidaemia, hyperkalaemia, hyperuricaemia,
hypomagnesaemia, hypertension, hirtsutism/hypertrichosis, hepatic impairment,
renal impairment, leucopenia
-Most side effects are dose dependent and respond favourable to dose reductions
• Side effects are more common where higher doses and longer durations of use are
involved

Question 4

what are other important side effects of using ciclosporin as an immunosuppressant?

Answer 4

Immunosuppression increases the risk of infections
• Immunosuppression increases the risk of developing – lymphomas and malignancies
(esp. skin)

Question 5

what are some contraindications for ciclosporin?

Answer 5

-Abnormal baseline renal function
• Malignancy
• Uncontrolled hypertension
• Uncontrolled infection

Question 6

who should use with caution?

Answer 6

• Elderly
• Gout
• Hepatic impairment

Question 7

what should be monitored at baseline and throughout treatment while on cicslosporin?

Answer 7

• Renal function
• Hepatic function
• BP
• Lipids
• Electrolytes – potassium, magnesium,
• Uric acid

Question 8

what are some interactions with ciclosprin?

Answer 8

-metabolised by CYP450 inhibitor liek macrolides, diltiazem, verapamil, lercanidipine, fluconazole,
itraconazole, ketoconazole, grapefruit juice → ↑blood ciclosporin levels
-• CYP450 inducers – rifampicin, carbamazepine, phenobarbital, phenytoin, St. John Wort
→ ↓ blood ciclosporin levels
• Statins – avoid or dose reductions
• Nephrotoxic drugs – NSAIDs, MTX
• Any drugs causing effects as seen with ciclosporin
• i.e. K+ sparing diuretics
• Ciclosporin inhibits cyp 3A4, p-glycoprotein and Organic Anion Transporter proteins

Question 9

what are the differences between ciclosporin IV and oral prepartion?

Answer 9

• Differences in IV and oral preparations -
• The oral dose of ciclosporin is approximately 3 times that of the IV formulation
• Specific information relating to the oral solution -
• Required dose should be mixed with orange or apple juice immediately before
administration

Question 10

what is some advice for patients when using ciclosporin?

Answer 10

• Twice a day preparation
• Should be maintained on the same brand of ciclosporin
• Consistency of administration – time of day and proximity to food
• Avoid live vaccines