Calcineurin inhibitor
Ciclosporin
Brand names: Neoral, Sandimmun, Capimune, Deximune, Vanquoral
Adult dose
Dose: Varies by indication. Psoriasis/eczema: 2.5–5mg/kg/day in 2 divided doses. Refer to brand-specific dosing — formulations are NOT interchangeable
Route: PO/IV
Frequency: BD
Clinical pearls
- Prescribe by brand — bioavailability varies
- Monitor trough levels in transplant settings
- Avoid grapefruit juice
Contraindications
- Uncontrolled hypertension
- Uncontrolled infection
- Malignancy (relative)
- Severe renal impairment (relative)
Side effects
- Nephrotoxicity
- Hypertension
- Tremor
- Gingival hyperplasia
- Hypertrichosis
- Hyperkalaemia
- Hyperlipidaemia
- Increased malignancy risk
Interactions
- CYP3A4 inhibitors (azoles, macrolides, grapefruit) — toxicity
- CYP3A4 inducers (rifampicin, phenytoin) — loss of effect
- Statins — myopathy risk
- NSAIDs — nephrotoxicity
Monitoring
- Trough levels
- U&E
- BP
- LFTs
- Lipids
- Magnesium
Reference: BNF; NICE TA180; https://bnf.nice.org.uk/drugs/ciclosporin/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- Travis Criteria for Severe Ulcerative Colitis · Inflammatory Bowel Disease
- Immune-Related Adverse Events (irAE) -- GI Toxicity Colitis Grading · Oncology-Related GI
- irAE Hepatitis Grading (CTCAE) · Immunotherapy
- DIPSS — Dynamic International Prognostic Scoring System for Myelofibrosis · Cancer Prognosis
Pathways
- Cutaneous Lupus Erythematosus · BAD; EULAR
- Osteoporosis / Fragility Fracture · NOGG 2021; NICE NG147; NG224
- Arteritic AION (Giant Cell Arteritis) · RCOphth; BSR
- Osteoarthritis Hip / Knee Management · NICE NG226 (2022)
- Lupus Nephritis · EULAR/ERA-EDTA 2019; KDIGO 2024
- Rheumatoid Arthritis Management · NICE CG79 2018 / EULAR 2022