Systemic Immunosuppressant — Eczema / Psoriasis Pregnancy: Should not be used during pregnancy unless the potential benefit to the mother outweighs the potential risk to the foetus; animal studies show embryofoetal toxicity below the maximum recommended human dose, and there is a risk of premature delivery. Not recommended during breast-feeding (enters breast milk; potential for adverse reactions in the infant). Ethanol content of the formulation should also be considered.

Ciclosporin

Brand names: Neoral, Capimune, Sandimmun

Ciclosporin is a calcineurin-inhibitor immunosuppressant used in severe inflammatory skin disease (e.g. psoriasis, atopic eczema), other autoimmune conditions, and transplantation.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Non-transplantation (dermatological) indications: given orally in 2 divided doses; except in sight-threatening endogenous uveitis and children with nephrotic syndrome, the total daily dose must never exceed 5 mg/kg

Route: Oral (soft capsules; two divided doses daily)

Frequency: Twice daily (daily dose split into 2 divided doses)

Max: Non-transplant indications: total daily dose must never exceed 5 mg/kg (except sight-threatening endogenous uveitis and children with nephrotic syndrome)

Capimune 100 mg soft capsules (SPC). NOTE: the fetched §4.2 text did not contain a specific numeric psoriasis or atopic dermatitis regimen (section truncated) — clinician to confirm the exact dermatological starting/maintenance dose against the full SPC / a current prescribing reference; the 5 mg/kg/day cap above is the SPC's general rule for non-transplant indications. Only prescribe by, or in close collaboration with, a physician experienced in immunosuppressive therapy. Before starting, establish a reliable baseline renal function from at least two measurements (eGFR by MDRD in adults). Reduce dose by 25-50% if eGFR falls >25% below baseline at more than one measurement; consider further reduction if the fall exceeds 35%; discontinue if dose reduction does not improve eGFR within one month. For maintenance, use the lowest effective and well-tolerated dose. Numeric non-transplant regimens present in the fetched text: endogenous uveitis 5 mg/kg/day (up to 7 mg/kg/day in refractory cases for a limited period); nephrotic syndrome adults 5 mg/kg/day. Warn dermatology patients (psoriasis/atopic dermatitis) to avoid excess unprotected sun exposure and not to receive concomitant UVB or PUVA photochemotherapy (skin malignancy risk).

Dose adjustments

Renal

Since ciclosporin can impair renal function, monitor frequently: reduce dose by 25-50% if eGFR falls >25% below baseline at more than one measurement; consider further reduction if the fall exceeds 35%; discontinue if reduction does not improve eGFR within one month.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Instill one drop of VEVYE twice a day in each eye approximately 12 hours apart. ( 2 ) 2.1 Recommended Dosage Instill one drop of VEVYE twice a day in each eye approximately 12 hours apart. 2.2 Administration Instructions Wash hands before using. Gently pull the lower eyelid downward. Tip the bottle upside down over the eye to allow one drop to dispense on its own into the eye. If a drop does not dispense after a few seconds, gently apply slight pressure to the sides of the bottle while holding over the eye. Note: You may not feel the drop falling into your eye. If VEVYE is used with other eye drops, a 15-minute interval between products should occur.

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2026-02-26. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or any excipient
Combination with products containing Hypericum perforatum (St John's Wort)
Combination with medicines that are substrates for P-glycoprotein (Pgp) or organic anion transporter proteins (OATP) for which elevated plasma concentrations are associated with serious/life-threatening events, e.g. bosentan, dabigatran etexilate, aliskiren

Side effects

Renal dysfunction (dose-dependent rise in serum creatinine and urea)
Tremor and headache (very common)
Hirsutism
Hypertension
Gastrointestinal: anorexia, nausea, vomiting, diarrhoea
Hyperlipidaemia (very common); hyperuricaemia, hyperkalaemia, hypomagnesaemia

Interactions

St John's Wort (Hypericum perforatum) — contraindicated
Pgp/OATP substrates with serious risk at raised levels: bosentan, dabigatran etexilate, aliskiren — contraindicated
Substances that interfere with ciclosporin pharmacokinetics — monitor ciclosporin blood levels when co-administered
Nephrotoxic drugs / factors — additive renal impairment risk (dose-dependent nephrotoxicity)

Clinical monograph

How it works

It inhibits calcineurin, blocking T-lymphocyte activation and interleukin-2 production.

Prescribing in practice

Nephrotoxicity and hypertension are dose-related and key limiting effects — monitor renal function and blood pressure closely.
It has many interactions (a CYP3A4/P-glycoprotein substrate and inhibitor); grapefruit juice raises levels, and gum hypertrophy and increased hair growth occur.
Whole-blood levels are monitored in transplantation; avoid live vaccines and counsel on infection and malignancy risk.

Monitoring

Monitor renal function, blood pressure, potassium and lipids, and (in transplantation) drug levels; review interactions.

Counselling the patient

Avoid grapefruit juice.
Tell your clinician about any new medicines, as ciclosporin interacts widely.
Use sun protection and attend your monitoring blood tests.

Evidence & guidelines

An option for severe psoriasis and atopic eczema and other autoimmune disease, limited by nephrotoxicity and hypertension.

Reference: BAD Atopic Eczema Systemic Guidelines 2020; BAD Psoriasis Guidelines; MHRA Drug Safety Update; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways