Type of Medication: Immunosuppressant .

Indications: Immunosuppression. Prevention of transplanted organ rejection.

Side Effects:Dose dependant increase in urea and creatinine(usually during first few weeks), less commonly renal structural changes on long term administration;hypertrichosis, headache, tremor, hypertension, hepatic dysfunction, fatigue, gingival hypertrophy, GI disturbances, burning sensation in hands and feet, headaches, rash, anaemia, hyperkalaemia, gout, hypomagnesaemia, oedema hypercholesterolaemia, weight increase, neuropathy, confusions, amennorrhoea, dysmennorrheoa, muscle weakness, pancreatitis, hyperchlolesterolaemia, oedema, gynaecomastia, neuropathy, confusion, paraesthesia, convulsions, cramps, myopathy, cortical blindness, colitis, thrombocytopenia, lymphoproliferative disorders, renal tubular acidosis. 

Route of administration: Adult (Oral)

Dose:Post-transplant immunosuppression. Adjusted according to target plasma level. Always discuss with transplant unit.

Administration: Give in 2 divided doses. Take with pancreatic enzymes supplements. Don’t mix with grapefruit juice. Measure trough plasma concentration. Monitor U&Es,LFT’s, creatinine, lipids and BP. Reduce dose if creatinine increases by 50%.

Examples of some Drug Interactions

Interacting drug: ACE inhibitors

increase risk of hyperkalaemia

Interacting drug: Allopurinol

plasma concentration of ciclosporin increased

Interacting drug: Amiloride

increased risk of hyperkalaemia

Interacting drug: Aminoglycosides

increase risk of nephrotoxicity

Interacting drug: Amphotericin

increase risk of nephrotoxicity

Interacting drug: Cimetidine

increases ciclosporin level

Interacting drug: Ciprofloxacin, Colistin, Co-trimoxazole, Vancomycin

increase risk of nephrotoxicity

Interacting drug: Diclofenac

plasma level of diclofenac is doubled – half diclofenac dose

Interacting drug: Digoxin

plasma conctration of digoxin increases, risk of digxin toxicity

Interacting drug: Erythromycin, Clarithromycin

increase cyclosporin level

Interacting drug: Fluconazole, Itraconazole, Ketoconazole, Voriconazole

increase ciclosporin level

Interacting drug: Grapefruit juice

increases ciclosporin concentration

Interacting drug: Methotrexate

increased toxicity

Interacting drug: Methyl Prednisolone

increases ciclosporin level

Interacting drug: NSAID

increased risk of nephrotoxicity

Interacting drug: Prednisolone

prednisolone level increased

Interacting drug: Progestogens

increase ciclosporin levels

Interacting drug: Rifampicin

reduces ciclosporin plasma concentration

Interacting drug: Tacrolimus

plasma ciclosporin concentration increased – increased risk of toxicity, avoid concomitant use.

Interacting drug: Trimethoprim

plasma concentration of ciclosporin reduced by intravenous trimethoprim

Interacting drug: Ursodeoxycholic acid

increases ciclosporin absorption

Interacting drug: Vaccines

do not give live vaccines to patients on immunosuppression. Other vaccines may give reduced host response