Ciclosporin
A DRUG Information Sheet
Why am I being prescribed ciclosporin?
Ciclosporin (brand name Neoral) 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.
Grapefruit or grapefruit juice should not be taken for 1 hour before the dose of ciclosporin.
What dose do I take?
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.
How long will 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?
Two possible side-effects of ciclosporin are a rise in blood pressure and effects on the kidneys.
In some people ciclosporin can cause sickness (nausea), diarrhoea, headache, gum overgrowth, tiredness, excess hair growth, and increased levels of lipids (e.g. cholesterol) in the blood. It can also produce a mild tremor. Sometimes a burning sensation of the hands and feet occurs early in treatment. Ciclosporin can also affect the liver, but this seems to occur only with doses much higher than those used for arthritis.
Side-effects of ciclosporin may get better if the dose is reduced.
If you develop any new symptoms after starting this drug, you should inform your doctor or rheumatology nurse specialist as soon as possible. If any of these symptoms are severe, you should stop ciclosporin and see your doctor immediately.
If you have not had chickenpox but come into contact with someone who has chickenpox or shingles, or if you develop chickenpox or shingles, you should stop ciclosporin and see your doctor immediately as you may need special treatment. This is because chickenpox and shingles can be severe in people on treatment such as cicloporin which has effects on the immune system (the body's own defence system). Therefore you may require antiviral treatment.
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 (see arc leaflet 'Drugs and Arthritis'). Your rheumatologist will discuss these other options with you.
Do 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. Bring this with you when you visit your general practitioner or the hospital. You must not take ciclosporin unless you are having regular checks.
May I take other medicines along with ciclosporin?
Ciclosporin may be prescribed along with other drugs, including methotrexate (see separate arc leaflet 'Methotrexate'). Special care is needed with non-steroidal anti-inflammatory drugs (NSAIDs). You may only take anti-inflammatory drugs if they are prescribed to you by your doctor.
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.
Ciclosporin is not a painkiller. So if you are on painkillers you may continue to take these as well as ciclosporin, unless your doctor advises otherwise.
Do not take over-the-counter preparations without discussing this first with your doctor, rheumatology nurse or pharmacist.
Can I have immunisations while 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 and yearly flu vaccines are safe and recommended.
May I drink alcohol while taking ciclosporin?
You may drink alcohol while taking ciclosporin. However, if you are also taking methotrexate, you should only drink alcohol in small amounts because methotrexate and alcohol can interact and damage your liver.
Does ciclosporin affect 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 while taking ciclosporin.
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 the content of this information sheet is correct at time of going to press, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.
