Pharmacy - Ciclosporin

Why have I been prescribed ciclosporin?

Ciclosporin is a medicine that can be used to manage auto immune conditions. It is used in several specialities including renal, dermatology, rheumatology & neurology. It is also used as an anti-rejection medicine after organ transplantation to stop the body rejecting the transplant. The clinician that recommends this medicine for you will tell you about your condition and why ciclosporin is being prescribed.

How does it work?

Ciclosporin belongs to a group of medicines known as immunosuppressants. It helps to reduce or supress your body’s own immune system to limit or prevent tissue damage rather than having an immediate effect on symptoms. Your immune system helps to protect you against infections. However, sometimes it can overreact or react abnormally and cause illness. Ciclosporin can be used to treat these conditions, often in combination with other medicines.

Ciclosporin works slowly and may take up to 12 weeks to take effect.

Unless you have severe side effects it is important to continue taking it even if you do not notice any change in your symptoms.

What dose do I take?

The dose of ciclosporin depends on your weight and the medical condition being treated. Your dose will also depend on blood tests.

How do I take it?

Ciclosporin is available in different brands. It is important that you stay on the same brand. Ciclosporin is taken twice a day (12 hours apart).

The capsules should be taken with a full glass of water. Ciclosporin is also available as a liquid to drink. For this method of taking ciclosporin, you’ll need to measure out the correct dose using the syringe that comes with your medicine. Mix it with water and stir it well. After you’ve taken it, add some more water, swish the water around and drink that, to make sure you’ve taken all the medicine.

Ideally, ciclosporin should be taken consistently in relation to food. The instructions on how to take your ciclosporin will be on a printed label on the box. You should take the medicines as directed by your doctor.

Do not chew or open the capsules.

Does ciclosporin interfere with my other medicines?

Ciclosporin can interact with other medicines. You should tell your doctor which medicines you are taking before starting ciclosporin.

Other medicines which can cause problems with ciclosporin include:

• Some antifungal and antibiotic medications, e.g. fluconazole and clarithromycin
• Anti-epileptic medication, e.g. phenytoin and carbamazepine
• Some blood pressure medications, e.g. diltiazem and verapamil
• If you are on a statin then the dose may need to be adjusted
• You should only take non-steroidal anti-inflammatory drug (NSAIDs) on the advice of your GP or clinician
• St John’s wort and some other herbal preparations should be avoided
• Avoid drinking grapefruit juice
• You should avoid ‘live’ vaccines but most travel vaccines and the ‘flu jab & COVID vaccines are ok

This list is not exhaustive so always check with your doctor or pharmacist first before starting any new medication.

It is safe to drink alcohol in moderation while taking ciclosporin but you are recommended to have alcohol free days without saving units up to drink all in one go.

Can ciclosporin cause side effects?

All medicines can cause unwanted side effects. Side effects that can occur with ciclosporin include:

• You are more likely to catch infections so avoid close contact with people with severe active infections. If you catch an infection (temperature >39 degrees, unresolving cough/cold, flu or COVID symptoms), contact your health professional for advice
• Stomach upsets, such as feeling sick or diarrhoea
• Headache, tremor or high blood pressure
• Increase in lipids (fatty substances in the blood)
• Feeling dizzy, blurred vision
• Ciclosporin can affect your kidneys and liver, so you will need to have regular blood tests to monitor the levels
• Overgrowth of gums
• Excessive hair growth

In the long-term there is a higher risk of tumours including skin cancers and a condition called lymphoproliferative disorders compared to the general population. We recommend that you use a high factor sun cream (SPF 30 or more) to prevent skin damage and regular surveillance, such as cervical screening (smear tests) for women.

What happens if I forget to take a dose?

If you remember within 6 hours of your dose being due then take your dose as usual. If it is more than 6 hours since your dose was due, do not take the dose and take your next dose at the normal time.

Is it ok to have ciclosporin during pregnancy and breastfeeding?

If you are planning to become pregnant while you are taking ciclosporin, you should discuss this with your clinical team. You should avoid becoming pregnant whilst taking ciclosporin. You should not breast feed whilst taking ciclosporin.

Do I need any special checks while on ciclosporin?

Ciclosporin can affect your immune system and other blood cells. Although these effects are rare, it is important that you have regular blood tests to check for early signs of changes in the blood.

Tips to reduce your risk of infection

• Try to avoid close contact with people you know have an infection
• Wash your hands regularly and carry round a small bottle of antibacterial gel to use
• Keep your mouth clean by brushing your teeth regularly
• Make sure your food is stored and prepared properly
• Try to keep your house clean and hygienic, especially the kitchen, bathrooms and toilets
• Have your yearly ‘flu vaccine and COVID boosters

Can I travel while taking ciclosporin?

If you are planning on travelling whilst taking ciclosporin, it is important to discuss this with the specialist clinic. Keep in mind the following advice:

• Always take extra supplies of your medication when travelling
• Keep your medication in your hand luggage
• Carry your medication in their original boxes
• If you’re travelling to a different time zone, try to take your medication at your usual 'native' time. If this is difficult, discuss with your clinician in the clinic

In many parts of the world there is a greater risk of developing an infection. To help avoid picking up these infections you must:

• Wash your hands thoroughly, especially after using public toilets
• Use alcohol hand gel: you can buy this from most supermarkets and chemists to take with you
• Follow the advice below on food and water safety:
  –    Don’t drink tap water or use it to brush your teeth. Use bottled water instead.
  –    Don’t put ice in drinks
  –    Bottled fizzy drinks with an unbroken seal are usually safe
  –    Boiled water and drinks made with boiled water are usually safe
  –    Don’t eat salads, raw (uncooked) fruits and vegetables, unless you have washed and peeled them yourself
  –    Don’t eat food that has been kept at room temperature in warm places or that could have been exposed to flies
  –    Don’t eat or drink unpasteurised milk, cheese, ice cream or other dairy products
  –    Don’t eat raw or undercooked seafood

Can I have vaccinations while taking ciclosporin?

Whilst taking ciclosporin, you must not have any live vaccines. Your immune system is dampened down whilst taking ciclosporin, which increases your risk of infection. Other types of vaccines are safe for you to have. Ensure you discuss any vaccinations you need with the clinic.

We strongly advise that all patients who have a reduced immune system have the flu vaccination each year and follow the recommended COVID vaccination schedule – your clinical team will advise you. If your GP or Practice Nurse needs advice about vaccinations, they can contact the clinic.

Contact details

Medicines information: 0161 206 5223