Ciclosporin, an immunosuppressant Neoral

About ciclosporin

Ciclosporin belongs to a group of medicines called immunosuppressants. It is used to reduce rejection following organ and bone marrow transplantation, and to treat a variety of long-term (chronic) inflammatory and autoimmune diseases. It will be prescribed for you by a specialist doctor.

To reduce organ rejection: your body can try to reject new donor tissue following organ or bone marrow transplants. Ciclosporin helps to prevent this by suppressing your body's immune, or defence, system.

To treat long-term inflammatory and autoimmune diseases: in conditions such as rheumatoid arthritis, and severe dermatitis and psoriasis, ciclosporin can help to reduce your symptoms by suppressing your immune system. Nephrotic syndrome is a condition where large amounts of protein leak from your blood into your urine because the 'filters' in your kidney are not working properly. Ciclosporin can help to correct this too.

In addition to the medical conditions listed above, ciclosporin is also sometimes prescribed by specialist doctors for people with ulcerative colitis (although the medicine is not licensed for use in this condition). If you have been prescribed it for this reason, please speak with your doctor if you have any questions about your treatment.

Before taking ciclosporin

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking ciclosporin it is important that your doctor knows:

• If you are pregnant, trying for a baby or breastfeeding.
• If you have any problems with the way your liver works, or any problems with the way your kidneys work (unless this is the reason for the treatment).
• If you have high blood pressure.
• If you currently have an infection.
• If you have cancer (unless this is the reason for the treatment).
• If you have been told you have high levels of uric acid in your blood.
• If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
• If you have ever had an allergic reaction to a medicine.

How to take ciclosporin

• Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about ciclosporin and how to take it. It will also provide you with a full list of side-effects which you could experience from taking the medicine.
• Your doctor will prescribe a dose for you which is tailored to your weight and the reason why you are taking it. It is usual to take two doses of ciclosporin each day (morning and evening). There are several strengths of capsule available and it is possible that your dose may include more than one strength. Make sure that you take ciclosporin exactly as your doctor tells you to. Your dose will be printed on the label(s) of the pack(s) to remind you about what the doctor said to you.
• Try to take your doses at the same times of day each day, as this will help you to remember to take your doses regularly. If you do forget to take a dose, take it as soon as you remember (unless it is nearly time for your next dose, in which case leave out the missed dose). Do not take two doses together to make up for a forgotten dose.
• If you have been given capsules to take, swallow each dose with a small glass of water. Do not chew or open the capsules.
• If you have been given the oral solution (liquid medicine), follow the manufacturer's instructions closely. Measure out your dose using the oral dose syringes provided, and then add it to a glass of water. Stir it well before you drink. To make sure that you take the full dose, after you've swallowed the drink, add a little more water to the empty glass, swirl it around and then drink this too. You can take your dose mixed into orange juice (or squash) or apple juice instead of water if you prefer, but you must never mix it with grapefruit juice. Do not wash the oral dose syringe out after you have used it; simply wipe it clean with a dry tissue.
• Your doctor will tell you how long your treatment is expected to continue. This may range from several weeks up to a year. Please keep taking ciclosporin until your doctor tells you otherwise.

Getting the most from your treatment

• Do not drink grapefruit juice while you are on ciclosporin. This is because a chemical in grapefruit juice increases the amount of ciclosporin in your bloodstream. This makes side-effects more likely.
• There are a number of different brands of ciclosporin available and these are not all absorbed by your body in exactly the same way. Because of this, your doctor will prescribe the same brand of ciclosporin for you each time you need a new supply. If when you collect a new supply it looks different to what you have had before, please ask your pharmacist to check this out for you and advise you about what you should do.
• Try to keep all your regular appointments with your doctor. This is so your doctor can check on your progress. Your doctor will want to monitor your blood pressure and do some blood tests, both before and during the treatment, to check that your kidneys and liver are working well. Ciclosporin can change the levels of some electrolytes (salts) and lipids (fats) in your blood and your doctor will want to check for this too.
• While you are taking ciclosporin, and for a while after you stop treatment, do not have any immunisations (vaccinations) without talking to your doctor first. Ciclosporin lowers your body's resistance and there is a risk that you may get an infection from the vaccine. Also, some vaccines can be less effective.
• Your doctor will discuss with you the possibility of a slightly increased risk of cancer (particularly skin cancer) associated with immunosuppressants like ciclosporin. Because of this it is important that you do not use sunbeds, and that you avoid strong sunlight and use a sun cream with a high sun protection factor (SPF of at least 15). If you have psoriasis, do not have PUVA or UVB treatments.
• You should avoid becoming pregnant while you are taking ciclosporin. Make sure you have discussed with your doctor which types of contraception are suitable for you and your partner.
• If you are due to have an operation or any dental treatment, please tell the person carrying out the treatment that you are taking ciclosporin.
• If you buy any medicines or herbal remedies, please check with your doctor or a pharmacist that they are safe for you to take. This is because ciclosporin interferes with the way a number of other medicines work, and vice versa. Also, some anti-inflammatory painkillers which can be bought over-the-counter increase the risk of side-effects from ciclosporin and should be avoided.
• If you drink alcohol, please ask your doctor for advice. Many ciclosporin preparations contain a small amount of alcohol and your doctor may recommend that you avoid alcoholic drinks.

Can ciclosporin cause problems?

Your doctor will have discussed with you the possibility of unwanted side-effects and how you will be regularly checked for signs of these. You will also have been told that you may become more prone to infections. Some of the more common unwanted effects of ciclosporin are listed below. Let your doctor know if any of the following continue or become troublesome, or if you experience any other symptoms which you are concerned about or think may be due to the medicine.

Important: please tell your doctor if you get any problems with your eyesight. This is because there is a condition called benign intracranial hypertension which has, on very rare occasions, developed in some people taking ciclosporin. Your doctor will want to check for this.

How to store ciclosporin

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines