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Ciclosporin Monitoring — SCE Dermatology MCQ

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ModerateDermatopharmacologyCiclosporin MonitoringSCE Dermatology

A 40-year-old woman on Ciclosporin for severe atopic eczema has her blood pressure checked at routine monitoring. It is 155/95 mmHg on two occasions. According to BAD guidelines, what is the recommended action?

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Correct answer: B — Reduce Ciclosporin dose by 25-50%

Hypertension is a well-recognised adverse effect of Ciclosporin due to renal afferent arteriolar vasoconstriction and sodium retention. BAD guidelines recommend reducing the Ciclosporin dose by 25-50% if hypertension develops during treatment. If blood pressure does not normalise with dose reduction, treatment should be stopped. BP monitoring is required every 2 weeks for the first 3 months, then monthly. An antihypertensive can be added (Nifedipine or Amlodipine — NOT Diltiazem or Verapamil, which inhibit CYP3A4 and increase Ciclosporin levels). Creatinine must also be monitored (>30% rise requires dose reduction).

Reference: BAD 2018 Drug Monitoring Guidelines; BNF