Like penicillin, cyclosporine was discovered as a substance produced by fungi. It was found to suppress the immune system and was developed for suppressing the immune system of transplant patients to prevent them rejecting their transplanted organs. It was subsequently found to benefit patients with a range of diseases caused by immune reactions.
In “auto-immune” diseases, the immune system attacks the body itself. These diseases can affect just one organ - such as the heart, liver or skin - or a number of organs.
There are also diseases in which the body’s immune system becomes overactive, letting a disease persist or even get worse. Suppressing the immune system can then be helpful.
After transplant surgery, the immune system has to be suppressed to stop the transplanted organ being rejected. Most patients who have had a kidney or heart transplant take cyclosporine as part of the combination of drugs used to suppress their immune system.
Conditions best treated with Cyclosporine
Cyclosporine is prescribed for conditions in which the immune system is too active. It is only licensed to treat psoriasis and eczema. However, drugs are often used for conditions not included in the original licence application. In the case of cyclosporine, these include bullous pemphigoid, pyoderma gangrenosum, chronic actinic dermatitis, and cutaneous vasculitis.
None of the skin conditions for which cyclosporine is used are ‘cured’ by this treatment. Usually a gradual improvement is seen, starting in the first few weeks of treatment, and then cyclosporine treatment will be continued to keep the skin problem under control.
What is involved in taking Cyclosporine
Your doctor will advise you here as the dose prescribed depends partly on your body weight. Cyclosporine is usually taken in capsule form twice daily. The capsules are available in 4 strengths: 10, 25, 50 or 100mg. Cyclosporine is also available as a liquid. The total dose is usually within the range of 2-5 mg/kg body weight per day. Grapefruit or grapefruit juice should not be taken for one hour before or after the dose of cyclosporine as it affects absorption of the drug.
Side effects of Cyclosporine treatments
In some people cyclosporine can cause sickness (nausea), diarrhea, gum overgrowth, tiredness and excessive hair growth. It can also produce a mild tremor. Sometimes a burning sensation of the hands and feet occurs early in treatment. If cyclosporine is used at a high dose it can also affect the liver. The side effects of cyclosporine tend to get better if the dose is reduced.
The long-term side effects of cyclosporine include reduced function of the kidneys and raised blood pressure. The dose of cyclosporine has to be reduced or stopped if there is a rise in blood pressure or effects on the kidneys. Provided the treatment is monitored and appropriate adjustments are made, these side effects are reversible. Cyclosporine can also cause increased levels of lipids (for example cholesterol) in the blood.
Taking cyclosporine for a number of years increases your risk of getting some types of cancer. This includes skin cancer, and patients on cyclosporine should limit their sun exposure. You should talk to your doctor about this if you are worried.
Cyclosporine makes you more prone to infections. You should see your doctor if you develop a sore throat or any other infection. If you come into contact with someone who has chicken pox you should inform your doctor promptly as it may be necessary for you to be given an injection of immunoglobulin to protect you.
Monitoring for the side effects of Cyclosporine treatment
As cyclosporine can affect the kidneys and blood pressure, your doctor will arrange for you to have regular tests of your blood and urine, and checks on your blood pressure. These tests will be carried out frequently at first and less often once the dose is stable.
- You may be asked to keep a record booklet with your test results. Take this with you when you visit your general practitioner or go to hospital.
- You must not take cyclosporine unless you are having regular checks.
Vaccinations while on Cyclosporine
You should avoid immunization injections with any of the live vaccines such as polio and rubella (German measles). Flu vaccines and Pneumovax are safe and recommended.
If you are pregnant
It is best not to take cyclosporine when pregnant - but it is possible. If you are planning a family, or if you become pregnant while taking cyclosporine, you should discuss this with your doctor as soon as possible. You should not breast feed while taking cyclosporine.
Alcohol and medications while on Cyclosporine
There is no particular reason for you to avoid alcohol while taking cyclosporine.
Cyclosporine may be prescribed in combination with other drugs. However, some other drugs interact with it and you should always tell any doctor treating you that you are taking cyclosporine. You should not take over-the-counter preparations without discussing this first with your doctor or pharmacist.
However, many drugs can be safely taken with cyclosporine.
Drugs that may interact with cyclosporine include:
- Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs): e.g. ibuprofen and diclofenac.
- Antibiotics: erythromycin, clarithromicin, trimethoprim, ciprofloxacin, rifampicin and doxycycline.
- Antifungals: fluconazole, itraconazole, ketoconazole and amphotericin B.
- Treatment for seizures: phenytoin and carbamazepine.
- Blood pressure treatments: ACE inhibitors, beta-blockers and calcium channel blockers.
- Hormones: oral contraceptives and corticosteroids.
- Digoxin: This is not an exhaustive list and it is important that you always inform your doctor and pharmacist that you are taking cyclosporine.