What are the aims of this leaflet?

This leaflet has been written to help you understand more about ciclosporin.  It tells you what it is, how it works, how it is used to treat skin conditions, and where you can find out more about it. 

What is ciclosporin and how does it work?

Like penicillin, ciclosporin was discovered as a substance produced by fungi. It was found to suppress the immune system and was developed for suppressing the immune system of transplant patients to prevent them rejecting their transplanted organs. It was subsequently found to benefit patients with a range of diseases caused by immune reactions.

Why suppress the immune system?

There are several reasons:

• In “auto-immune” diseases, the immune system attacks the body itself.  These diseases can affect just one organ - such as the heart, liver or skin - or a number of organs.
• There are also diseases in which the body’s immune system becomes overactive, letting a disease persist or even get worse.  Suppressing the immune system can then be helpful.
• After transplant surgery, the immune system has to be suppressed to stop the transplanted organ being rejected. Most patients who have had a kidney or heart transplant take ciclosporin as part of the combination of drugs used to suppress their immune system. 

Which skin conditions are treated with ciclosporin?

Ciclosporin is prescribed for conditions in which the immune system is too active. It is only licensed to treat psoriasis and eczema. However, drugs are often used for conditions not included in the original licence application. In the case of ciclosporin, these include bullous pemphigoid, pyoderma gangrenosum, chronic actinic dermatitis, and cutaneous vasculitis.

Will ciclosporin cure my skin condition?

None of the skin conditions for which ciclosporin is used are ‘cured’ by this treatment. Usually a gradual improvement is seen, starting in the first few weeks of treatment, and then ciclosporin treatment will be continued to keep the skin problem under control. 

What dose should I take?

Your doctor will advise you here and the dose prescribed depends partly on your body weight. Ciclosporin is usually taken in capsule form twice daily. The capsules are available in 4 strengths: 10, 25, 50 or 100mg. Ciclosporin is also available as a liquid. The total dose is usually within the range of 2-5 mg/kg body weight per day. Grapefruit or grapefruit juice should not be taken for one hour before or after the dose of ciclosporin as it affects absorption of the drug.

What are the possible side effects of ciclosporin?

In some people ciclosporin can cause sickness (nausea), diarrhoea, gum overgrowth, tiredness and excessive hair growth. It can also produce a mild tremor. Sometimes a burning sensation of the hands and feet occurs early in treatment. If ciclosporin is used at a high dose it can also affect the liver.  The side effects of ciclosporin tend to get better if the dose is reduced. 

Are there any other side effects if ciclosporin is taken for a long time?

The long-term side effects of ciclosporin include reduced function of the kidneys and raised blood pressure. The dose of ciclosporin has to be reduced or stopped if there is a rise in blood pressure or effects on the kidneys. Provided the treatment is monitored and appropriate adjustments are made, these side effects are reversible. Ciclosporin can also cause increased levels of lipids (for example cholesterol) in the blood.

Taking ciclosporin for a number of years increases your risk of getting some types of cancer. This includes skin cancer, and patients on ciclosporin should limit their sun exposure. You should talk to your doctor about this if you are worried. 

You should avoid chicken pox. If you do come into contact with someone who has chicken pox you should inform your doctor promptly as it may be necessary for you to be given an injection of immunoglobulin to protect you (See separate British Association of Dermatologists patient information leaflet on this website for further information on immunisation recommendations for adult patients taking immune-suppressing medicines).

How will I be monitored for the side effects of ciclosporin treatment? 

Because ciclosporin can affect the kidneys and blood pressure, your doctor will arrange for you to have regular tests of your blood and urine, and checks on your blood pressure. These tests will be carried out frequently at first and less often once the dose is stable. You may be asked to keep a record booklet with your test results. Bring this with you when you visit your general practitioner or go to hospital. 

You must not take ciclosporin unless you are having regular checks.

Does ciclosporin affect fertility or pregnancy?

It is best not to take ciclosporin when pregnant - but it is possible. If you are planning a family, or if you become pregnant while taking ciclosporin, you should discuss this with your doctor as soon as possible. You should not breast feed while taking ciclosporin. 

May I drink alcohol while taking ciclosporin?

There is no particular reason for you to avoid alcohol while taking ciclosporin.

Can I take other medicines at the same time as ciclosporin?

Ciclosporin may be prescribed in combination with other drugs.  However, some other drugs interact with it and you should always tell any doctor treating you that you are taking ciclosporin. You should not take over-the-counter preparations without discussing this first with your doctor or pharmacist. However, many drugs can be safely taken with ciclosporin. 

Drugs that may interact with cyclosporin include:

Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs): e.g. ibuprofen and diclofenac.

Antibiotics: erythromycin, clarithromicin, trimethoprim, ciprofloxacin, rifampicin and doxycycline.

Antifungals: fluconazole, itraconazole, ketoconazole and amphotericin B.

Treatment for seizures: phenytoin and carbamazepine.

Blood pressure treatments: ACE inhibitors, beta-blockers and calcium channel blockers.

Hormones: oral contraceptives and corticosteroids.

Digoxin 

This is not an exhaustive list and it is important that you always inform your doctor and pharmacist that you are taking ciclosporin.

Can I have immunisation injections while on ciclosporin?

You should avoid immunisation injections with any of the live vaccines such as polio and rubella (German measles). Flu vaccines and Pneumovax are safe and recommended. 

Where can I find out more about ciclosporin?

If you would like any further information about ciclosporin, or if you have any concerns about your treatment, you should discuss this with your doctor or pharmacist. This information sheet does not list all the side effects this drug can cause. For full details, please see the drug information leaflet that comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to side effects that may be relevant in your particular case.

http://www.bad.org.uk/public/leaflets/immunisation.asp  

The British Skin Foundation fund vital research into all skin diseases.  To find out how you can help, please visit the British Skin Foundation website here.

(While every effort has been made to ensure that the information given in this leaflet is accurate, not every treatment will be suitable or effective for every person. Your own doctor will be able to advise in greater detail)

PATIENT INFORMATION LEAFLET  
 PRODUCED OCTOBER 2007