Ciclosporin

Dose ranges are guidelines only; give on a consistent schedule relative to meals. Only to be prescribed by/with a physician experienced in immunosuppressive therapy and/or transplantation, with ciclosporin blood-level monitoring. When combined with other immunosuppressants (e.g. corticosteroids, triple/quadruple therapy), lower initial doses (e.g. 3-6 mg/kg/day in two divided doses) may be used. Bone marrow transplantation: IV concentrate 3 to 5 mg/kg/day is usually preferred initially for up to 2 weeks, then oral maintenance ~12.5 mg/kg/day in 2 divided doses (continue at least 3 months, preferably 6, then taper to zero by 1 year); if oral used to initiate, 12.5 to 15 mg/kg/day in 2 divided doses from the day before transplantation. GVHD after discontinuation: oral loading dose 10 to 12.5 mg/kg then previous maintenance dose. Non-transplantation indications: establish baseline renal function (>=2 measurements) before starting; except in sight-threatening endogenous uveitis and children with nephrotic syndrome, the total daily dose must never exceed 5 mg/kg. Endogenous uveitis: initially 5 mg/kg/day orally in 2 divided doses (up to 7 mg/kg/day in refractory cases for a limited period). Nephrotic syndrome (normal renal function): adults 5 mg/kg/day, children 6 mg/kg/day in 2 divided oral doses; if renal impairment, initial dose not to exceed 2.5 mg/kg/day. If eGFR falls >25% below baseline on more than one measurement, reduce dose by 25-50%; discontinue if dose reduction does not improve eGFR within one month.