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Conventional DMARD — Calcineurin Inhibitor

Ciclosporin (Rheumatology)

Brand names: Neoral, Sandimmun

This is ciclosporin used specifically within rheumatology as a calcineurin-inhibitor disease-modifying antirheumatic drug for severe active rheumatoid arthritis and selected connective-tissue diseases.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It inhibits calcineurin after binding cyclophilin, suppressing interleukin-2-driven T-cell activation and the inflammatory cascade in autoimmune joint disease.

Prescribing in practice

  • Renal impairment and hypertension are dose-limiting — check renal function and blood pressure at baseline and regularly, reducing or stopping if creatinine climbs.
  • Avoid combining with other nephrotoxic agents and with potassium-raising drugs, and beware CYP3A4 interactions.
  • Use brand-specific prescribing as bioavailability differs between formulations; consult the SPC for rheumatology indications.

Monitoring

Track creatinine, blood pressure, potassium, lipids and liver function throughout treatment, adjusting therapy if nephrotoxicity emerges.

Counselling the patient

  • Attend all blood-pressure and blood-test reviews.
  • Avoid grapefruit and disclose every other medicine.
  • Report reduced urine output, swelling or infection.

Evidence & guidelines

Efficacy in refractory rheumatoid arthritis is established by randomised trials and reflected in UK rheumatology guidance.

Reference: BSR/BHPR Rheumatoid Arthritis Guidelines; MHRA Ciclosporin Monitoring Guidance; SPC Neoral; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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