Ciclosporin

How it works

It binds cyclophilin and inhibits calcineurin, blocking the transcription of interleukin-2 and other cytokines and thereby suppressing T-lymphocyte activation.

Prescribing in practice

• Nephrotoxic and hypertensive — renal function and blood pressure must be measured before and regularly during treatment, with dose reduction or withdrawal if creatinine rises persistently.
• Numerous interactions occur via CYP3A4 and P-glycoprotein; avoid concurrent live vaccines and minimise other nephrotoxins.
• Prescribe and dispense by brand name because formulations are not interchangeable, and check the SPC for the relevant indication.

Monitoring

Monitor serum creatinine, blood pressure, potassium, liver function, lipids and (where indicated) blood ciclosporin concentrations during therapy.

Counselling the patient

• Report swelling, reduced urine output or persistent headache.
• Avoid grapefruit juice and tell clinicians about all other medicines.
• Use sun protection and attend monitoring appointments.

Evidence & guidelines

Long-standing use is supported by controlled trials and UK guidance for severe refractory inflammatory arthritis.