Ciclosporin (brand name Neoral) is a type of drug known as a
disease-modifying anti-rheumatic drug, or DMARD. These drugs have
the effect of dampening down the underlying disease process, rather
than simply treating symptoms. Ciclosporin reduces the activity of
the immune system (the body’s own defence system), so it is always
used with care.
Why is ciclosporin prescribed?
Ciclosporin is used for rheumatoid arthritis
to reduce pain, swelling and stiffness. It is also used for a
number of other conditions, including psoriatic arthritis and
systemic lupus erythematosus (SLE).
When and how do I take ciclosporin?
Ciclosporin is usually taken in capsule form
twice a day. It is also available as a liquid.
Your doctor will advise you about the correct
dose. Usually you will start on a low dose, and your doctor may
increase this if necessary. The dose you are given will depend on
your body weight and how well your kidneys are working.
Note: Grapefruit or
grapefruit juice should not be taken for 1 hour before the dose of
ciclosporin because these can increase the amount of ciclosporin
available in the body and so increase the risk of side-effects.
How long does ciclosporin take to work?
Ciclosporin does not work immediately. It may
take up to 4 months to produce a beneficial effect.
What are the possible risks or side-effects?
Possible side-effects of ciclosporin are a
rise in blood pressure and effects on the kidneys. It can also
affect the liver, but this seems to occur only with doses much
higher than those used for arthritis. Ciclosporin can sometimes
cause increased levels of lipids (e.g. cholesterol) in the
blood.
You should tell your doctor or rheumatology
nurse specialist if you develop any of the following after starting
ciclosporin:
- nausea (feeling sick)
- diarrhoea
- headache
- gum overgrowth
- tiredness
- excess hair growth
- a mild tremor
- a burning sensation of the hands and feet early in
treatment
- any other new symptoms or anything else that concerns you.
Because ciclosporin can affect the gums, it is
important to visit your dentist regularly.
You should stop ciclosporin and see your
doctor immediately if:
- any of the symptoms listed above are severe
- you have not had chickenpox and you come into contact with
someone who has chickenpox or shingles
- you develop chickenpox or shingles.
Chickenpox and shingles can be severe in people on treatments
such as ciclosporin which affect the immune system. Therefore you
may need antiviral treatment, which your doctor will be able to
prescribe.
Side-effects of ciclosporin may get better if the dose is
reduced.
What other treatments could be used instead of
ciclosporin?
A number of other drugs are used in the treatment of rheumatoid
arthritis and related conditions. Your doctor will discuss these
other options with you.
Will I need any special checks while on ciclosporin?
Because ciclosporin can affect the kidneys and
blood pressure, your doctor will arrange for you to have a blood
and urine test and blood pressure measurement before you start
treatment and then regular checks while on ciclosporin. You may be
asked to keep a record booklet with your test results, and you
should bring this with you when you visit your GP or the hospital.
You must not take ciclosporin unless you are having regular
checks.
Can I take other medicines along with ciclosporin?
Ciclosporin may be prescribed along with other
drugs in treating your condition. You should discuss any new
medications with your doctor before starting them, and you should
always tell any other doctor treating you that you are taking
ciclosporin.
Special care is needed with non-steroidal anti-inflammatory
drugs (NSAIDs). You may only take NSAIDs if they are prescribed to
you by your doctor.
Ciclosporin is not a painkiller. If you are already on
painkillers you can carry on taking these as well as ciclosporin,
unless your doctor advises otherwise.
Do not take over-the-counter preparations or herbal remedies
without discussing this first with your doctor, rheumatology nurse
or pharmacist.
What about immunisations?
If you are on ciclosporin it is recommended that you should not
be immunised with ‘live’ vaccines such as yellow fever. However, in
certain situations a live vaccine may be necessary (for example
rubella immunisation in women of childbearing age), in which case
your doctor will discuss the possible risks and benefits of the
immunisation with you.
Pneumovax (which gives protection
against the commonest cause of pneumonia) and yearly flu vaccines
are safe and recommended.
Can I drink alcohol while on ciclosporin?
There is no particular reason to avoid
alcohol while on ciclosporin.
Does ciclosporin affect fertility or pregnancy?
It is best not to take ciclosporin when
pregnant. If you are planning a family or if you become pregnant
while taking ciclosporin you should discuss this with your doctor
as soon as possible.
What about breastfeeding?
You should not breastfeed if you are
on ciclosporin. The drug may pass into the breast milk and could be
harmful to your baby.
Where can I obtain further information?
If you would like any further information
about ciclosporin, or if you have any concerns about your
treatment, you should discuss this with your doctor, rheumatology
nurse or pharmacist.
Remember to keep all medicines out of reach of
children.
PLEASE NOTE: We have made every effort to
ensure that this content is correct at time of publication, but
remember that information about drugs may change.
This page is for general education only and does not
list all the uses and side-effects associated with this
drug. For full details please see the drug information
leaflet that comes with your medicine. Your doctor will assess your
medical circumstances and draw your attention to any information or
side-effects that may be relevant in your particular case.
Our drug information is revised
annually and published at the start of the year.