ciclosporin at a glance
Medicine class
Calcineurin inhibitor and immunosuppressant
Available routes
Capsules, oral solution, hospital intravenous infusion and eye drops have distinct uses and instructions.
What is ciclosporin used for?
UK products include systemic immunosuppression and topical treatment of dry eye disease.
Preventing or treating rejection after solid-organ transplantation.
Preventing rejection after allogeneic bone-marrow or stem-cell transplantation, and preventing or treating graft-versus-host disease.
Selected severe inflammatory conditions: non-infectious endogenous uveitis, nephrotic syndrome, active rheumatoid arthritis, psoriasis and atopic dermatitis.
Moderate to severe dry eye disease in adults when tear substitutes have not provided sufficient improvement; this applies to selected eye drops.
Specialist non-licensed treatment of severe ulcerative colitis that has not responded to standard therapy.
How does ciclosporin work?
Ciclosporin inhibits calcineurin signalling in activated T cells, reducing immune-signalling proteins including interleukin-2. This suppresses transplant rejection and damaging inflammation. In dry eye disease, local immune suppression reduces inflammation at the eye surface.
ciclosporin preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 50 mg/mL
Eye drops
Route: Ophthalmic
Strengths: 0.9 mg/mL, 1 mg/mL
Capsule
Route: Oral
Strengths: 25 mg, 50 mg, 100 mg
How to take ciclosporin
Follow the instructions for your formulation. Do not switch brand or formulation without specialist supervision.
Swallow capsules whole and take them consistently in relation to food.
Measure oral solution with the supplied syringe. Mix it immediately before use with a suitable drink such as apple or orange juice, stir well and drink the entire mixture. Do not use grapefruit juice or rinse the syringe with water.
For eye drops, wash your hands and avoid touching the dropper tip to your eye or another surface. Remove contact lenses before use and follow the product instructions before reinserting them.
Hospital intravenous concentrate must be diluted and administered by healthcare professionals because it carries a risk of serious infusion reactions.
ciclosporin side effects
Common or expected effects
- Headache or tremor
- High blood pressure
- Kidney-function changes
- Nausea, vomiting, abdominal discomfort or diarrhoea
- Increased hair growth
- Swollen or overgrown gums
- Muscle aches or cramps
- Burning, irritation or temporary blurred vision with eye drops
Get urgent medical advice
- Serious or unusual infection
- Kidney injury, including markedly reduced urine
- Liver injury, including jaundice
- Seizures, confusion or major visual disturbance
- Severe allergic or infusion reaction
- Blood disorders causing unexplained bruising, bleeding or marked weakness
- New or changing skin lesions, swollen lymph nodes or other possible malignancy symptoms
ciclosporin in pregnancy
Systemic ciclosporin can be used during pregnancy when a specialist judges that controlling inflammatory disease or preventing transplant rejection outweighs potential risks. Seek an early specialist review when planning a pregnancy or becoming pregnant rather than stopping abruptly. Selected eye drops are not recommended unless the expected maternal benefit outweighs potential fetal risk.
ciclosporin while breastfeeding
Systemic ciclosporin enters breast milk in variable amounts. Its product information recommends against breastfeeding because long-term infant risks remain uncertain. A specialist should assess the maternal indication, infant health and possible monitoring. Exposure from selected eye drops is expected to be negligible, although their product information advises avoiding use during breastfeeding as a precaution.
ciclosporin interactions
Ciclosporin has many important interactions. Check prescribed, pharmacy-bought and herbal products before starting or stopping them.
St John’s wort
Contraindicated with systemic ciclosporin because it can lower ciclosporin exposure and reduce immunosuppression.
Macrolide antibiotics and azole antifungals
Erythromycin, clarithromycin, fluconazole and itraconazole can substantially increase ciclosporin exposure and toxicity risk.
Rifampicin and enzyme-inducing antiseizure medicines
They can lower ciclosporin concentrations and jeopardise disease or transplant control.
Common questions about ciclosporin
Answers are fully visible for fast scanning and source review.
Why must ciclosporin usually be prescribed by brand name?
Different oral products can produce clinically important differences in exposure. Switching should be specialist-led and appropriately monitored.
Can I drink grapefruit juice while taking ciclosporin?
No. Grapefruit can increase systemic ciclosporin exposure and adverse-effect risk; it must not be used to dilute the oral solution.
Why are blood tests and blood-pressure checks needed?
Ciclosporin can affect kidney and liver function, blood cells, glucose, lipids and electrolytes, and can cause hypertension. Monitoring helps detect toxicity.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.