Cyclosporine|Ciclosporin.

Generic name: Cyclosporine A.

Brand name: Neoral, Gengraf, Sandimmune.

Cyclosporine or Ciclosporin (as it is sometimes spelt) is an immunosuppressant drug (suppresses the immunity of the body), similar in effectiveness to Methotrexate. Besides its other uses, it is used in the treatment of severe forms of psoriasis that is widespread and difficult to treat.

It was first used to prevent organ rejection after organ transplant. It was approved as late as 1997 by the FDA for the treatment of severe psoriasis in adults with a normal immune system.

How to Use Cyclosporine.

Cyclosporine is available in microemulsion capsule and liquid form and is usually advised to be taken orally twice daily with or without food. Once started continue to take it in the same fashion – either with food or without it.

It is necessary that the levels of cyclosporine stay  consistent for maximum effects and therefore sticking to the same dosage and same time (of taking the drug) is advised. Dosage varies depending on the medical condition of the patient, kidney function and response to the drug.

The liquid form requires dilution preferably with room temperature orange or apple juice. Do not take grapefruit or its juice when on cyclosporine as it causes increased levels of this drug in the blood.

In psoriasis, it may take 2 to 4 weeks to notice any improvement and up to 4 months to see the full benefit. Long term use of cyclosporine in psoriasis is limited and unless advised by your dermatologist, this drug usage is advised for one year only.

Uses.

• Organ transplant.
• Psoriasis
• Rheumatoid arthritis.
• Atopic dermatistis.
• Chronic urticaria.
• As cyclosporine ophthalmic drops in dry eyes.
• Ulcerative colitis.

Adverse and Side Effects of Cyclosporine.

Many people do not develop side effects and though side effects exist, this medication is advised at times where its benefits far outweigh its side effects. Risk of side effects increase with higher dosage and long term therapy.

Being an immunosuppressant, risk of infections  and cancer are high when taking this drug. Risk of skin cancer with cyclosporine  increases if you have been previously treated with UVB, coal tar, radiation therapy, methotrexate or some other immunosuppressant drug. Other possible side effects are mentioned below:

• Headache
• Nausea and vomiting
• Blurring of vision
• Stomach upsets
• Increased hair growth on face and body
• Acne outbreaks
• Tremors
• Muscle, bone and joint pains
• Renal toxicity. The risk of this side effect increases when cyclosporine is taken with non steroidal anti-inflammatory drugs. The dose of cyclosporine is reduced if the creatinine levels rise more than 30%
• Increased blood pressure (hypertension) which is to be treated with anti hypertensive drugs
• High cholesterol
• A feeling of tiredness

Of all the oral drugs prescribed for severe psoriasis, cyclosporine is the safest drug that can be used in pregnancy. However, the FDA lists cyclosporine in the Category B list of drugs for pregnancy.

What is pregnancy  category B? Quoting from wikipedia below.

Pregnancy category B : Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.

Precautions when taking Cyclosporine.

• Stick to the same time and format when taking your dose to maintain same blood levels of this drug for better results.
• Blood pressure should be checked before starting this drug and also periodically when on this therapy.
• Similarly a watch on serum creatinine levels should also be carried out.

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