Cyclosporine

Indications for Treatment

Cyclosporine is a strong, immune suppressant medication. Its main uses are:

• Used to prevent the rejection of transplanted organs (i.e.: liver, kidneys, heart).
• Used to treat skin condition(s), such as:
• Severe Psoriasis
• Severe Atopic Dermatitis

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Mechanism of Action

In skin diseases, Cyclosporine acts by damping down inflammation in the skin by its effect on certain immune cells, lymphocytes.

Cyclosporine is generally taken by patients with severe skin disease(s) for a minimum for several months and up to several years.

Medication Instructions are:

• Dosing is generally 2.5mg/kg body weight per day.
• The capsules should be swallowed whole at the same time each day.
• Taken with a full glass of water.
• Taken after breakfast and after dinner.
• This medication should NOT be taken with grapefruit juice as this may unpredictably increase the amount of Cyclosporine absorbed into the blood stream.

Monitoring

As a ‘powerful’ medication, Cyclosporine can have serious side effects. It is essential to follow your physician’s advice regarding the monitoring of your health. This is especially important when initially prescribed the medication, even though some side effects do not become more likely until after several months’ of treatment.

• Blood pressure should be measured weekly for the first month.
• Then monthly thereafter.
• Kidney function should be tested by blood and urine tests.
• Especially Creatinine levels
• Other regular tests should include:

• Complete Blood Count
• Liver Functions
• Lipid Levels, fasting
• Uric Acid

Drug Interactions

Certain medication should be avoided by patients taking Cyclosporine. If it is essential to receive treatment with one of these medication(s), ensure your health is monitored carefully by the prescribing physician. The medication(s) include:

• NSAIDs – Ego Indomethacin, Naproxen

• Antibiotics – Septra, Trimethoprim, Rifampin, Erythromycin, Ciprofloxacin, Tobramycin, Gentamicin
• Anti-Epileptics – Phenytoin, Carbamazepine
• Anti-fungals – Amphotericin B, Ketoconazole, Itraconazole, Fluconazole
• St. John’s Wart (hypericum perforatum)

Side Effects

Side Effects from Cyclosporine may include:

• Hypertension
• Additional medication may be needed for control
• Renal Function reduction
• May require reducing the dose of Cyclosporine OR even stopping altogether
• Loss of Appetite
• Nausea
• Paresthesia – ‘pins and needles sensation’ in the fingers and toes
• Tremor
• Swollen/Bleeding gums
• Brush/Massage your teeth regularly with a soft toothbrush
• Use dental floss daily
• Attend routine dental check-ups.
• Increased risk of bacterial, fungal, and/or viral infection(s).
• See your physician promptly should you feel unwell.
• Potential increased risk of cancer.
• Particularly skin cancer.
• Protect yourself from sun exposure.
• Phototherapy (Ultraviolet treatment including UVB and PUVA) should be avoided while on Cyclosporine.
• Increased hair growth
• Bleaching, shaving, and hair removal creams/treatments can be used

If prescribed Cyclosporine for your skin condition, discuss the side effect(s) with your dermatologist. Make sure you understand what to expect and how to deal with and problems that may arise.

Once the skin disease(s) has stabilized on Cyclosporine, your dermatologist may advise you to slowly reduce the daily dose of medication to the minimum which controls the skin condition. It is often necessary to stop the medication altogether for a few months to allow side effects to resolve.

When Cyclosporine is discontinued, the skin disease will usually reappear, and can be retreated further with Cyclosporine or another medication.