Ciclosporin

PSORIASIS: an initial dose of 5 mg/kg/day is justified in patients whose condition requires rapid improvement. Treatment should be discontinued in patients in whom sufficient response of psoriatic lesions cannot be achieved within 6 weeks on 5 mg/kg/day, or in whom the effective dose is not compatible with the established safety guidelines. Once satisfactory response is achieved ciclosporin may be discontinued and subsequent relapse managed by re-introduction at the previous effective dose; some patients need continuous maintenance therapy, titrated individually to the lowest effective level and not exceeding 5 mg/kg/day. ATOPIC DERMATITIS: in very severe cases rapid and adequate control is more likely with a starting dose of 5 mg/kg/day. Once satisfactory response is achieved the dose should be reduced gradually and, if possible, ciclosporin discontinued, with relapse managed by a further course. An 8-week course may be sufficient to achieve clearing, but up to 1 year of therapy has been shown to be effective and well tolerated provided the monitoring guidelines are followed. Treatment for either indication should be initiated by physicians experienced in the diagnosis and treatment of that condition, and ciclosporin should only be prescribed by, or in close collaboration with, a physician experienced in immunosuppressive therapy. The dose ranges given for oral administration are intended to serve as guidelines only; for maintenance the lowest effective and well tolerated dosage should be determined individually, and treatment should be discontinued if no adequate response is achieved in the stated time or if the effective dose is not compatible with the established safety guidelines. BEFORE STARTING (general rules for all non-transplantation indications): establish a reliable baseline renal function from at least two measurements (eGFR by the MDRD formula in adults); determine bilirubin and parameters assessing hepatic function; serum lipids, potassium, magnesium and uric acid are advisable before and periodically during treatment; regular blood pressure monitoring is required. Occasional monitoring of ciclosporin blood levels may be relevant in non-transplant indications (e.g. co-administration with substances that interfere with ciclosporin pharmacokinetics, or unusual clinical response such as lack of efficacy or renal dysfunction). SKIN-CANCER WARNING (§4.4): patients on ciclosporin, in particular those treated for psoriasis or atopic dermatitis, should be warned to avoid excess unprotected sun exposure and should not receive concomitant UVB irradiation or PUVA photochemotherapy. ELDERLY (65 years and above): experience is limited; in rheumatoid arthritis trials patients aged 65 or older were more likely to develop systolic hypertension and serum creatinine rises of 50% or more above baseline after 3 to 4 months. Dose selection should be cautious, usually starting at the low end of the dosing range. SWITCHING between oral ciclosporin formulations should be made under physician supervision. The same SPC also covers transplantation, endogenous uveitis, nephrotic syndrome and rheumatoid arthritis; those regimens are deliberately NOT reproduced on this dermatology page (a prior verification pass flagged that quoting them here put a 7 mg/kg/day uveitis figure next to a 5 mg/kg/day dermatology ceiling). PAEDIATRIC: clinical studies included children from 1 year of age and paediatric patients required and tolerated higher doses per kg body weight than adults, but 'Use of Capimune in children for non-transplantation indications other than nephrotic syndrome cannot be recommended' — the SPC therefore states NO paediatric psoriasis or atopic dermatitis dose. Verify any under-18 use against a children's formulary. PRIOR VERIFY HOLD — NOW RESOLVED BY THE 2026-08-05 RE-FETCH: an adversarial verification pass held this entry on the grounds that 'No dermatological dose exists in the source at all... grep for psoriasis/atopic dermatitis in the source returns ONLY a §4.4 photo-safety warning, never a posology', because the earlier fetch of §4.2 was truncated before the dermatology sections. The re-fetched bundle (fetched 2026-08-05, §4.2 now 12,455 characters) contains both the 'Psoriasis' and 'Atopic dermatitis' posology headings verbatim, and the dose above is quoted directly from them. The same hold also noted that the bundle's openFDA cross-check is productName 'VEVYE' (ciclosporin 0.1% ophthalmic solution, Harrow Eye) — a different product and route; that remains true, so the US label in this bundle was NOT used for anything here. SOURCE CAVEATS STILL OPEN: the SPC fetched is Capimune 100 mg soft capsules (eMC product 695); the §4.3 contraindications list in the fetched text ends with a dangling bullet, so at least one further contraindication may not have been retrieved; §4.4, §4.6 and §4.8 are truncated at the source-fetch limit and §4.5 (interactions) was not retrieved at all.